Hurley J, Labelle R
Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
Health Econ. 1995 Nov-Dec;4(6):419-38. doi: 10.1002/hec.4730040601.
The study objective is to estimate the relationship between changes in the relative fee physicians receive for a procedure and the utilization of the procedure.
DATA SOURCES/STUDY SETTING: The study uses claims-based, procedure-specific, quarterly, aggregate utilization data for physicians in three specialties and four provinces in Canada for the period 1977-1989.
The unit of analysis is an individual procedure. Multi-variate regression methods for cross-sectional/times-series data are applied to estimate the utilization-fee relationship while controlling for supply- and demand-side determinants of utilization.
There is no evidence of a strong, uniform utilization response among the 11 procedures analyzed. The results include a mixture of significant and non-significant fee coefficients, and among the significant coefficients, a mixture of signs is observed. The results are consistent with utility-maximizing behaviour by physicians rather than with profit-maximizing behaviour.
The fact that the direction and degree of the utilization effect associated with changing fees is procedure-specific has direct implications for our ability to develop effective policies to modify physician behaviour that are based primarily on financial incentives, particularly those based on manipulating fees. The study also highlights the limitations of analyses based on aggregate data and suggests methodological approaches that have potential to overcome some of these limitations to fill gaps in our current knowledge.
本研究的目的是评估医生进行某项手术所获得的相对费用变化与该手术的使用情况之间的关系。
数据来源/研究背景：本研究使用了基于索赔的、特定手术的季度汇总使用数据，这些数据来自1977年至1989年期间加拿大三个专业领域和四个省份的医生。
分析单位是单个手术。运用适用于横截面/时间序列数据的多元回归方法来估计使用-费用关系，同时控制使用情况的供给侧和需求侧决定因素。
在所分析的11项手术中，没有证据表明存在强烈、一致的使用反应。结果包括显著和不显著的费用系数，在显著系数中，观察到正负号混合的情况。这些结果与医生的效用最大化行为一致，而非利润最大化行为。
与费用变化相关的使用效果的方向和程度因手术而异，这一事实对我们制定主要基于经济激励措施（特别是基于操纵费用）来改变医生行为的有效政策的能力具有直接影响。该研究还强调了基于汇总数据进行分析的局限性，并提出了一些方法，这些方法有可能克服其中一些局限性，以填补我们当前知识的空白。
