Nguyen N X, Derrick F W
Infrastructure Capital Group, Washington, DC, USA.
Health Serv Res. 1997 Aug;32(3):283-98.
To investigate at the individual practice level physician behavioral responses to the Medicare fee reductions mandated in the Omnibus Budget Reconciliation Act of 1989. Symmetric and nonsymmetric behavioral responses are modeled and investigated.
Volume index calculated from data in the Part B Medicare Annual Data (BMAD) Provider Files for 1989 and 1990. The pricing data are from the Procedure Files.
A fixed-effects model in carrier and in specialty is employed.
No direct data collection is required as BMAD files are used in the study. Price and volume variables are expressed as Fisher indexes of change.
The results show nonsymmetrical behavioral response because practices that did not face significant fee reductions do not exhibit behavioral change. By contrast, losers partially compensate for the fee reductions. For every dollar cut in their fees, physicians recoup approximately 40 cents by increasing volume. Loser behavioral responses vary by specialty.
The presence of a volume response suggests that price control alone is not sufficient to cap rising healthcare costs. This indicates that additional or other tools must be considered if cost containment is to be attained.
在个体医疗实践层面研究医生对1989年《综合预算协调法案》规定的医疗保险费用削减的行为反应。对对称和非对称行为反应进行建模并展开研究。
根据1989年和1990年医疗保险B部分年度数据（BMAD）提供者文件中的数据计算得出的量指数。定价数据来自程序文件。
采用按承保公司和专业划分的固定效应模型。
由于研究使用BMAD文件，因此无需直接收集数据。价格和量变量表示为变化的费雪指数。
结果显示存在非对称行为反应，因为未面临大幅费用削减的医疗实践未表现出行为变化。相比之下，费用削减的医疗实践会部分抵消费用削减的影响。每削减一美元费用，医生通过增加诊疗量大约可收回40美分。费用削减的医疗实践的行为反应因专业而异。
存在量反应表明仅靠价格控制不足以限制不断上涨的医疗成本。这表明如果要实现成本控制，必须考虑额外的或其他工具。
