Lec8_physicians_handout

Lec8_physicians_handout - The Physician Market, Part 1 The...

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The Physician Market, Part 1 The Physician Market, Part 1 Professor Vivian Ho Health Economics Fall 2009 These slides summarize material in Santerre & Neun: Health Economics, Theories Insights and Industry Studies, Southwestern Cengate 2010
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OUTLINE OUTLINE Physician Market Structure Conduct in the Physician Market Physician Market Performance Physician Practice Management Companies
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1970 1990 2003 2005 Total Number 334,028 615,421 871,535 902,053 Patient care 83.4% 81.9% 79.4% Total per 100,000 pop'n 161 244 295 304 Trends in Physician Numbers Physician Market Structure
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Physician Distribution by Major Specialties (Percent) 1975 2003 2006 Anesthesiology 3.3 4.4 9.98 Cardiovascular Diseases 1.8 2.6 5.02 Diagnostic Radiology 0.9 2.7 2.97 General Surgery 8.0 4.3 2.66 Opthamology 2.8 2.1 1.61 Orthopedic Surgery 2.9 2.7 4.7 Pathology 3.0 2.1 0.98 Psychiatry 6.1 4.6 1.28 Primary care specialists* 38.8 40.2 46.95 *The AMA defines primary care as including family practice, general practice, internal medicine, obstetrics/gynecology, and pediatrics. Physician Market Structure (cont.)
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Are there “too many” specialists Are there “too many” specialists and “too few” primary care docs? and “too few” primary care docs? Proportion of specialists in U.S. higher than in W. European countries and Canada (60% vs. 25-50%). Specialists more prone to use new, high- tech medical procedues. May explain why U.S. medical costs per capita are highest in the world.
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Matching Physician Supply & Matching Physician Supply & Requirements Requirements “Future physician supply does not appear well-matched with requirements. (Politzer, 1996) A shortage of 33,000 primary care physicians is predicted by 2020. The same set of assumptions also generates a surplus of specialists.
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Distribution of Physicians by Mode of Practice Most docs self-employed, but % is dropping. Fall in solo practice docs, rise in salaried docs. Reflects rise in ambulatory care by HMOs. Employment type 1989 1998 1999 2001 Self-employed 70.1% 62.3 51.4 54.8 Employee 23.9 36.1 48.6 45.2 Independent contractor 6.0 1.6 -- -- Size of practice Solo Practice 37.4% 25.9 22.0 20.5 2-8 persons 25.5 29.0 -- -- 2-9 persons -- -- 15.8 26.4 8+ persons 7.2 16.7 -- -- 10+ persons -- -- 12.5 14.9
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Distribution of Physician Revenues by Source of Payer % of revenues from Medicare/Medicaid high, but lower than for hospital sector. % of revenues paid out-of-pocket also higher than for hospital sector. 1980 2002 2007 Government 30.5 33.8 33.7 Medicare 17.4 20.3 20.1 Medicaid 5.2 7.2 6.9 Private 69.4 66.1 55.9 Priv. Health Insurance 35.3 49.1 49.4 Other Priv. Funds 3.9 6.9 6.5 Out-of-pocket 30.2 10.1 10.4
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Managed Care Reimbursement of Physicians Physicians MCOs hope to modify physician behavior in order to control costs. 88% of all practicing docs in 2001 had
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This note was uploaded on 12/06/2011 for the course ECON 101, 102, taught by Professor Staff during the Fall '10 term at Rutgers.

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Lec8_physicians_handout - The Physician Market, Part 1 The...

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