Physicians Flashcards
Physician services as % of medical spending trend. How do they impact spending directly and indirectly?
Physician services as % of medical spending trend. How do they impact spending directly and indirectly?
- stable
-
directly:
- patients visiting the doctor
-
indirectly:
- prescribe medicines
- Decide to admit patients to a hospital
Over time there’s been a shift away from solo practices and smaller group practices towards larger group practices
Why?
3 advantages of group practices
Over time there’s been a shift away from solo practices and smaller group practices towards larger group practices
Why?
- impact of increases in managed care
Physician groups can
- better negotiate payment rates with insurers
- handle the risk associated with capitated payments
- pool the administrative resources necessary to handle increasingly complex contracts
_ in the number of physicians per capita has been concentrated in the number of _
of physicians per 1000 is _ in US compared to other countries
Growth in the number of physicians per capita has been concentrated in the number of specialists
of physicians per 1000 is lower in US compared to other countries
Physician Supply: Shortage v. surplus
Too few physicians? (2)
Too many physicians overall? Too many specialists?
Physician Supply: Shortage v. surplus
Too few physicians?
- Poor access to care (main reason)
- High prices (or lower quality) due to a lack of competition (secondary reason)
Too many physicians overall? Too many specialists?
- Higher spending potentially due to “supplier induced demand”
Increased in med school enrollment (2)
Increases in enrolled
- Med school subsidies from government
- New med school openings
Concerns that the match system benefits the residency programs too much (3)
-
Compensation
- Residents have little ability to negotiate with programs; programs don’t really compete with salary and benefits
-
Hours
- Residents work long hours
-
Quality and errors in work
- Long hours during residency programs also raise issues regarding quality/errors
Physician salaries in US and other countries
Specialist _ Primary care
Medicine _ other occupations
US _ other countries
2 reasons why this might be
Physician salaries in US and other countries
Specialist > Primary care
Medicine > other occupations
US > other countries
Why?
- the private orientation of the financing of health care in the US
- higher amounts of student loan debt incurred by graduates of US medical schools
Explain physicians’ real income increase or decrease
Explain physicians’ real income increase or decrease
Nominal change in income - change in price inflation
Why did real physician incomes fall between 1995 and 2003?
what kind of doctors were impacted the most?
Why did real physician incomes fall between 1995 and 2003?
- private and public insurers reduced payments
what kind of doctors were impacted the most?
- decreases in real income were larger in magnitude for primary care physicians compared to specialist
decreasing real physician incomes between 1995-2003. How did private contribute? How did public contribute
decreasing real physician incomes between 1995-2003 (slowed growth)
Private
- Increase in managed care
Public
- SGR caused small increase in Medicare fees
- state budgetary pressures small increase in Medicaid fees
What caused the increase in physician real income in the early 2000s?
What caused the increase in physician real income in the early 2000s?
- retreat from more aggressive forms of managed care
describe the 2 major factors that impact the number of medical school applicants?
increase
decrease
describe the 2 major factors that impact the number of medical school applicants?
Increase
- federal policy to increase the number of physicians after the introduction of Medicare and Medicaid
- Income Rises
Decrease
- falling incomes
- physicians became less autonomous due to the rise of managed care utilization review
IOM definition of quality:
The degree to which _ for individuals and populations increase the likelihood of _ and are consistent with current _
IOM definition of quality:
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
Three types of problems regarding quality:
Three types of problems regarding quality:
- Underuse: the failure to provide an appropriate service
- Overuse: a service’s risk outweighs its benefit
- Misuse: the right service provided incorrectly
Example of Overuse: The Dartmouth Atlas Data
Example of Overuse: The Dartmouth Atlas Data
- additional spending on Medicare isn’t generally associated with relatively better outcomes or relatively better quality of care*
- supplier-induced demand (agressive)
