The impact of financial incentives on physician behavior in managed care plans: A review of the evidence

Medical Care Research and Review

Volumn 53, Issue 3, 1996, Pages 294-314

  Hellinger, Fred J ^a  

^a AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CLINICAL PRACTICE; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; ECONOMICS; HEALTH CARE AND PUBLIC HEALTH; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; HEALTH SERVICES RESEARCH; METHODOLOGY; PERSONNEL MANAGEMENT; RANDOMIZED CONTROLLED TRIAL; REVIEW; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

HEALTH CARE AND PUBLIC HEALTH;

HEALTH MAINTENANCE ORGANIZATIONS; HEALTH SERVICES RESEARCH; MANAGED CARE PROGRAMS; PHYSICIAN INCENTIVE PLANS; PHYSICIAN'S PRACTICE PATTERNS; RANDOMIZED CONTROLLED TRIALS; UNITED STATES; UTILIZATION REVIEW;

EID: 0030239619     PISSN: 10775587     EISSN: None     Source Type: Journal    
DOI: 10.1177/107755879605300305     Document Type: Review

References (31)

1. Appleby, C. 1995. The measure of medical services. Hospital & Health Networks 69 (June 20): 26-34.
2. Clancy, C. M., and B. E. Hillner. 1989. Physicians as gatekeepers: The impact of financial incentives. Archives of Internal Medicine 149 (April): 917-920.
3. Chernew, M. 1995. HMO use of diagnostic tests: A review of the evidence. Medical Care Research and Review 52 (June): 196-222.
4. Christensen, S. 1992. Volume response to exogenous changes in Medicare's payment policies. Health Services Research 27: 65-79.
5. Epstein, A. M., C. B. Begg, and B. J. McNeil. 1986. The use of ambulatory testing in prepaid and fee-for-service group practices: Relation to perceived profitability. The New England Journal of Medicine 314 (April 24): 1089-1094.
6. Garnick, D. W., H. S. Luft, L. B. Gardner, E. M. Morrison, M. Barrett, A. O'Neil, and B. Harvey. 1990. Services and charges by PPO physicians for PPO and indemnity patients: An episode of care comparison. Medical Care 28 (October): 894-906.
7. Gold, M., R. Hurley, T. Lake, T. Ensor, and R. Berenson. 1995. Arrangements between managed care plans and physicians: Results from a 1994 survey of managed care plans. Washington, DC: Physicians Payment Review Commission, February.
8. Gold, M., L. Nelson, T. Lake, R. Hurley, and R. Berenson. 1995. Behind the curve: A critical assessment of how little is known about arrangements between managed care plans and physicians. Medical Care Research and Review 52 (September): 307-341.
9. Greene, J., and S. Lutz. 1995. Hospital chains - A down year at not-for-profits; for-profits soar. Modern Healthcare 25 (May 22): 43-62.
10. Greenfield, S., E. C. Nelson, M. Zubkoff, W. Manning, W. Rogers, R. L. Kravitz, A. Keller, A. R. Tarlov, and J. E. Ware. 1992. Variations in resource utilization among medical specialties and systems of care: Results from the medical outcomes study. Journal of the American Medical Association 267 (March 25): 1624-1630.
11. Health News Daily. 1995. Half of U.S. physicians are associated with risk insurance plans, November 13, p. 4.
12. Hellinger, F. J. 1995. Selectionbias in HMOs and PPOs: Areview of the evidence. Inquiry 32 (Summer): 135-142.
13. Hickson, G. H., W. A. Altemeier, and J. M. Perrin. 1987. Physician reimbursement by salary or fee-for-service: Effect on physician practice behavior in a randomized prospective study. Pediatrics, 80: 344-350.
14. Hillman, A. L., M. V. Pauly, and J. J. Kerstein. 1989. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations. New England Journal of Medicine 321 (July 13): 86-92.
15. Hlatky, M. A., K. L. Lee, E. H. Botvinick, and B. H. Brundage. 1993. Diagnostic test use in different practice settings: A controlled comparison. Archives of Internal Medicine 143 (October): 1886-1889.
16. Holohan, J., A. Dor, and S. Zuckerman. 1990. Understanding the recent growth in Medicare physician expenditures. Journal of the American Medical Association 263: 1658-1661.
17. Lessler, D. S., and A. L. Avins. 1992. Cost, uncertainty, and doctors' decisions: The case of thrombolytic therapy. Archives of Internal Medicine 152 (August): 1665-1672.
18. Manning, W. F., A. Leibowitz, G. A. Goldberg, W. H. Rogers, and J. P. Rogers. 1984. A controlled trial of the effects of a prepaid group practice on use of services. New England Journal of Medicine 310 (June 7): 1505-1510.
19. Martin, D. P., P. Diehr, K. F. Price, and W. C. Richardson. 1989. Effect of a gatekeeper plan on health services use and charges: A randomized trial. American Journal of Public Health 79 (December): 1628-1632.
20. Miller, R., and H. S. Luft. 1994. Managed care plan performance since 1980. Journal of the American Medical Association 271 (May 18): 1512-1519
21. Mitchell, J., G. Wedig, and J. Cromwell. 1991. Physician response to fee changes with multiple payers. Journal of Health Economics 10: 385-410.
22. Murray, J. P., S. Greenfield, S. H. Kaplan, and E. M. Yano. 1992. Ambulatory testing for capitation and fee-for-service patients in the same practice setting: Relationships to outcomes. Medical Care 30 (March): 252-261.
23. Perkoff, G. T., L. Kahn, and P. J. Haas. 1976. The effects of an experimental prepaid group practice on medical care utilization and cost. Medical Care 14 (May): 432-449.
24. Perkoff, G. T., L. Kahn, and A. Mackie. 1974. Medical care utilization in an experimental prepaid group practice model in a university medical center. Medical Care 12 (June): 471-485.
25. Rapoport, J., S. Gehlbach, S. Lemeshow, and D. Teres. 1992. Resource utilization among intensive care patients: Managed care vs. traditional insurance. Archives of Internal Medicine 152 (November): 2207-2212.
26. Rice, T. 1983. The impact of changing Medicare reimbursement rates on physician-induced demand. Medical Care 21: 803-815.
27. Rice, T. and N. McCall. 1982. Changes in Medicare reimbursement in Colorado: Impact on physicians' economic behavior. Health Care Financing Review 3: 67-86.
28. Sexton, C. J., D. Morrill, and M. Matheny. 1995. Case study: Columbia/HCA in Florida. Health System Leader 2 (April): 14-20.
29. Sui, A. L., A. Leibowitz, R. H. Brook, N. S. Goldman, N. Lurie, and J. P. Newhouse. 1988. Use of the hospital in a randomized trial of prepaid care. Journal of the American Medical Association 259 (March 4): 1343-1346.
30. U.S. Congress. General Accounting Office. 1993. Managed health care: Effect on employers' costs difficult to measure. Washington, DC: U.S. Government Printing Office, GAO/ HRD-94-3.
31. Welch, W. P., A. L. Hillman, and M. V. Pauly. 1990. Toward new typologies for HMOs. Milbank Quarterly, 68 (2): 221-230.