Ohsfeldt R L, Morrisey M A, Nelson L, Johnson V
Lilly USA Health Outcomes Evaluation Group, Eli Lilly and Company, USA.
Health Serv Res. 1998 Dec;33(5 Pt 2):1537-62.
To describe the growth of any willing provider (AWP) and freedom of choice (FOC) laws applicable to managed care firms and to explore empirically the determinants of their enactment.
A 1996 compendium of state laws and state-level data from the 1991-1994 period.
Pooled cross-section time-series logistic regression of the decision to enact various types of AWP and FOC laws. Analysis uses a public choice framework to examine enactment. Key variables include proxy measures of proponent and opponent strength and the political environment.
The model works well for laws affecting hospitals, but performs poorly for physician and pharmacy laws. More providers are associated with the enactment of AWP and FOC laws. More large employers are associated with a reduced likelihood of enactment of some forms of the laws but not others. Conservative states are more likely to enact laws limiting selective contracting with hospitals and physicians. States with greater interparty competition are also more likely to adopt some types of legislation.
The empirical results generally are consistent with the view that AWP and FOC laws are often enacted as a defensive strategy on the part of providers, but additional research is needed to provide a more definitive assessment of the determinants of these laws. Suggestions for future research are provided.
描述适用于管理式医疗公司的任意意愿提供者（AWP）和选择自由（FOC）法律的发展情况，并通过实证研究探讨其颁布的决定因素。
1996年的州法律汇编以及1991 - 1994年期间的州级数据。
对颁布各类AWP和FOC法律的决定进行汇总截面时间序列逻辑回归分析。分析采用公共选择框架来考察法律颁布情况。关键变量包括支持者和反对者力量的代理指标以及政治环境。
该模型对影响医院的法律效果良好，但对涉及医生和药房的法律效果不佳。更多的提供者与AWP和FOC法律的颁布相关。更多大型雇主与某些形式法律颁布可能性降低相关，但并非所有形式。保守的州更有可能颁布限制与医院和医生进行选择性签约的法律。党派间竞争更激烈的州也更有可能采纳某些类型的立法。
实证结果总体上与以下观点一致，即AWP和FOC法律通常是提供者作为一种防御策略而颁布的，但需要更多研究以对这些法律的决定因素进行更明确的评估。提供了未来研究的建议。
