Escarce J J
Department of Medicine, University of Pennsylvania, Philadelphia.
Am J Public Health. 1993 Mar;83(3):349-55. doi: 10.2105/ajph.83.3.349.
Under the Omnibus Budget Reconciliation Act of 1987, Medicare reduced physician fees for 12 procedures identified as overprices. This paper describes trends in the use of these procedures and other physician services by Medicare patients during the 4-year period surrounding the implementation of the 1987 budget act.
Medicare physician claims files were used to develop trends in physician-services use from 1986 to 1989. Services were grouped into four categories: overpriced procedures, other surgery, medical care, and ancillary tests.
Growth in the volume of overpriced procedures slowed substantially after the 1987 budget act was implemented. Moreover, the reduction in the rate of volume growth for these procedures differed little among specialities or areas. In comparison, the rate of volume growth fell modestly for other surgery, was unchanged for medical care, and increased for ancillary tests.
Increases do not necessarily occur in the volume of surgical procedures whose Medicare fees are reduced. Although the conclusions that may be drawn from a descriptive analysis are limited, these findings suggest that concerns that the resource-based Medicare fee schedule will lead to higher surgery rates may be unwarranted.
根据1987年《综合预算调节法案》，医疗保险降低了12种被认定为定价过高的诊疗项目的医生收费标准。本文描述了在1987年预算法案实施前后4年期间，医疗保险参保患者对这些诊疗项目及其他医生服务的使用趋势。
利用医疗保险医生索赔档案来分析1986年至1989年期间医生服务使用情况的趋势。服务被分为四类：定价过高的诊疗项目、其他外科手术、医疗护理和辅助检查。
1987年预算法案实施后，定价过高的诊疗项目量的增长大幅放缓。此外，这些诊疗项目量增长速率的下降在不同专业或地区之间差异不大。相比之下，其他外科手术量的增长速率略有下降，医疗护理量的增长速率没有变化，辅助检查量则有所增加。
医疗保险费用降低的外科手术量不一定会增加。尽管描述性分析得出的结论有限，但这些发现表明，担心基于资源的医疗保险费用计划会导致更高的手术率可能是没有根据的。
