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Volumn 40, Issue 3, 2012, Pages 452-466

Effect of Financial Relationships on the Behaviors of Health Care Professionals: A Review of the Evidence

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL PRACTICE; CONFLICT OF INTEREST; DRUG INDUSTRY; ECONOMICS; ETHICS; HUMAN; LEGAL ASPECT; MOTIVATION; PATIENT REFERRAL; PHYSICIAN SELF-REFERRAL; POLICY; REIMBURSEMENT; UNITED STATES;

EID: 84867618342     PISSN: 10731105     EISSN: 1748720X     Source Type: Journal    
DOI: 10.1111/j.1748-720X.2012.00678.x     Document Type: Article
Times cited : (75)

References (89)
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    • For an example of this broader literature, see e.g., studying patients in 300 hospitals and finding that when Medicare switched to a prospective payment system in which hospitals were paid a fixed fee for each patient rather than based on the costs of care, patients were discharged sooner and in less stable condition); and M. Tickle, quot;Paying for the Wrong Kind of Performance? Financial Incentives and Behaviour Changes in National Health Service Dentistry,"Community Dentistry and Oral Epidemiology 39, no. 5 (2011): 465-473 (examining a conflict of interest situation for dentists).
    • For an example of this broader literature, see e.g., J. Kosecoff et al., "Prospective Payment System and Impairment at Discharge: The "Quicker-and-Sicker" Story Revisited, " JAMA 264, no. 15 (1990): 1980-1983. (studying patients in 300 hospitals and finding that when Medicare switched to a prospective payment system in which hospitals were paid a fixed fee for each patient rather than based on the costs of care, patients were discharged sooner and in less stable condition); and M. Tickle et al., "Paying for the Wrong Kind of Performance? Financial Incentives and Behaviour Changes in National Health Service Dentistry, "Community Dentistry and Oral Epidemiology 39, no. 5 (2011): 465-473 (examining a conflict of interest situation for dentists).
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    • This result was statistically significant at the .05 level, as are all other results discussed in this article, unless otherwise noted.
    • This result was statistically significant at the .05 level, as are all other results discussed in this article, unless otherwise noted.
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    • For additional research examining self-referrals in the urology specialty see H. J. Tan, "Use of Ureteroscopy Before and After Expansion of Lithotripter Ownership in Michigan, "Urology 78, no. 6 (2011): 1287-1291 (finding that physician ownership of lithiotripters did not decrease utilization of the substitute procedure, ureteroscpy);
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    • Note
    • In another study, drawing from two surveys of physical therapists, Mitchell and Sass sought to explore two alternative explanations as to why physicians purchase shares in physical therapy providers - to control the quality of services provided to the patients they refer or to profit from the physician's ability to steer patients by artificially inflating demand for a particular provider. J. M. Mitchell and T. R. Sass, "Physician Ownership of Ancillary Services: Indirect Demand Inducement or Quality Assurance?"Journal of Health Economics 14, no. 3 (1995): 263-289. The researchers found that "a physical therapy clinic that receives all of its referrals from physician owners treats a patient for approximately 50 percent more visits than a clinic that receives no referrals from owners."Id., at 285. Mitchell and Sass also observed that the differential is directly related to "increases in physician density, decreases in population density, and increases in the total number of owners, " which they argued were factors facilitating demand inducement.
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    • quot;The Emergence of Physician-Owned Specialty Hospitals,"
    • Similarly, in a 2005 article, Iglehart offered a case study documenting the impact of the opening of a specialty hospital in Oklahoma, near a university hospital. Iglehart reports that "the number of inpatients admitted for cardiac care plummeted at the university hospital after 16 surgeons and cardiologists on the clinical faculty began to refer all their patients to the specialty hospital as soon as it opened," resulting over $11.6 million in lost income for the university hospital over two years
    • Similarly, in a 2005 article, Iglehart offered a case study documenting the impact of the opening of a specialty hospital in Oklahoma, near a university hospital. Iglehart reports that "the number of inpatients admitted for cardiac care plummeted at the university hospital after 16 surgeons and cardiologists on the clinical faculty began to refer all their patients to the specialty hospital as soon as it opened, " resulting over $11.6 million in lost income for the university hospital over two years. J. K. Iglehart, "The Emergence of Physician-Owned Specialty Hospitals, "New England Journal of Medicine 352, no. 1 (2005): 78-84.
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