In the shadow of a giant medicare’s influence on private physician payments

Journal of Political Economy

Volumn 125, Issue 1, 2017, Pages 1-39

  Clemens, Jeffrey ^a   Gottlieb, Joshua D ^b  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b UNIVERSITY OF BRITISH COLUMBIA   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ADMINISTRATIVE FRAMEWORK; HEALTH EXPENDITURE; HEALTH SERVICES; PRICE DYNAMICS; PRIVATE SECTOR;

EID: 85009964431     PISSN: 00223808     EISSN: 1537534X     Source Type: Journal    
DOI: 10.1086/689772     Document Type: Article

References (66)

1. Acemoglu, Daron, and Amy Finkelstein. 2008. “Input and Technology Choices in Regulated Industries Evidence from the Health Care Sector.” J.P.E. 116 (5) 837-80.
2. Acemoglu, Daron, and Joshua Linn. 2004. “Market Size in Innovation Theory and Evidence from the Pharmaceutical Industry.” Q. J.E. 119 (3) 1049-90.
3. Anthem Blue Cross and Blue Shield. 2012. Anthem Blue Cross and Blue Shield Provider and Facility Manual. http//www.anthem.com/provider/nv/f5/s1/t0/pw_e188530.pdf.
4. Baicker, Katherine, and Dana Goldman. 2011. “Patient Cost-Sharing and Healthcare Spending Growth.” J. Econ. Perspectives 25 (2) 47-68.
5. Baker, Laurence C., M. Kate Bundorf, Anne B. Royalty, and Zachary Levin. 2014. “Physician Practice Competition and Prices Paid by Private Insurers for Office Visits.” J. American Medical Assoc. 312 (16) 1653-62.
6. Blue Cross and Blue Shield of Texas. 2010. “Fee ScheduleUpdates.” Blue Review (3) 15-16. http//www.bcbstx.com/provider/pdf/bluereview/br_issue3_2010.pdf.
7. Blue Cross and Blue Shield of Texas 2014. “HMO Blue® Texas-Blue Cross Blue Shield of Texas.” http//www.bcbstx.com/employer/products/2_50/hmo_blue_texas.htm.
8. Blue Cross Blue Shield of Michigan. 2013. “BCBSM Outpatient Psychiatric Care Facility Participation Agreement.” http//www.bcbsm.com/content/dam/public/Providers/Documents/enrollment/OPC-TRAD-WP-12946.pdf.
9. Blume-Kohout, Margaret E., and Neeraj Sood. 2013. “Market Size and Innovation Effects of Medicare Part D on Pharmaceutical Research and Development.” J. Public Econ. 97 (1) 327-36.
10. Blumenthal, David, and Sara R. Collins. 2014. “Health Care Coverage under the Affordable Care Act-a Progress Report.” New England J. Medicine 371 275-81.
11. Budish, Eric, Benjamin N. Roin, and Heidi Williams. 2015. “Do Firms Underinvest in Long-Term Research? Evidence from Cancer Clinical Trials.” A.E.R. 105 (7) 2044-85.
12. Chambers, James D., Matthew Chenoweth, Teja Thorat, and Peter J. Neumann. 2015. “Private Payers Disagree with Medicare over Medical Device Coverage about Half the Time.” Health Affairs 34 (8) 1376-82.
13. Chandra, Amitabh, Anupam B. Jena, and Jonathan S. Skinner. 2011. “The Pragmatist’sGuide to Comparative Effectiveness Research.” J. Econ. Perspectives 25 (2) 27-46.
14. Chandra, Amitabh, and Douglas O. Staiger. 2007. “Productivity Spillovers in Health Care Evidence from the Treatment of Heart Attacks.” J.P.E. 115 (1) 103-40.
15. Clemens, Jeffrey. 2013. “The Effect of U.S. Health Insurance Expansions on Medical Innovation.” Working Paper no. 19761, NBER, Cambridge, MA.
16. Clemens, Jeffrey, and Joshua D. Gottlieb. 2014. “Do Physicians’ Financial Incentives Affect Medical Treatment and Patient Health?” A.E.R. 104 (4) 1320-49.
17. Clemens, Jeffrey, Joshua D. Gottlieb, and Adam Hale Shapiro. 2014. “How Much Do Medicare Payment Cuts Reduce Inflation?” Fed. Reserve Bank San Francisco Econ. Letter, no. 2014-28.
18. CMS(Centers for Medicare and Medicaid Services). 2014. “National Health Expenditure Accounts.” http//www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE2013.zip.
19. CSHSC (Center for Studying Health System Change). 1999. “Physician Survey Summary File User’s Guide and Codebook.” Community Tracking Study Physician Survey, 1996-97 (ICPSR 2597). 10.3886/ICPSR02597.v3.
20. CSHSC (Center for Studying Health System Change) 2006. “2004-05 Physician Survey Summary File User’s Guide and Codebook.” Community Tracking Study Physician Survey, 2004-5 (ICPSR 4584). 10.3886/ICPSR04584.v2.
21. Cutler, David M. 1998. “Cost Shifting or Cost Cutting? The Incidence of Reductions in Medicare Payments.” In Tax Policy and the Economy, vol. 12, edited by James M. Poterba. Cambridge, MA MIT Press.
22. Cutler, David M. 2011. “Where Are the Health Care Entrepreneurs? The Failure of Organizational Innovation in Health Care.” In Innovation Policy and the Economy, vol. 11, edited by Josh Lerner and Scott Stern, 1-28. Chicago Univ. Chicago Press.
23. Cutler, David M., Mark McClellan, and Joseph P. Newhouse. 2000. “How Does Managed Care Do It?” RAND J. Econ. 31526-48.
24. Dafny, Leemore S. 2005. “Estimation and Identification of Merger Effects An Application to Hospital Mergers.” Working Paper no. 11673, NBER, Cambridge, MA.
25. Dafny, Leemore S., David Dranove, Frank Limbrock, and Fiona Scott Morton. 2011. “Data Impediments to Empirical Work on Health Insurance Markets.” BE J. Econ. Analysis and Policy 118.
26. Dafny, Leemore S., Mark Duggan, and Subramaniam Ramanarayanan. 2012. “Paying a Premium on Your Premium? Consolidation in the US Health Insurance Industry.” A.E.R. 102 (2) 1161-85.
27. Dall, Tim, TerryWest, Ritashree Chakrabarti, and Will Iacobucci. 2015. “The Complexities of Physician Supply and Demand Projections from 2013 to 2025.” Washington, DC Inst. Humane Studies (for American Assoc. Medical Col- leges). https//www.aamc.org/download/426242/data/ihsreportdownload.pdf?cm_mmc5AAMC-_-ScientificAffairs-_-PDF-_-ihsreport.
28. Department of Health and Human Services. 2013. “Projecting the Supply and Demand for Primary Care Practitioners through 2020.” Dept. Health and Human Services, Health Resources and Services Admin., Nat. Center HealthWorkforce Analysis, Rockville, MD. http//bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/projectingprimarycare.pdf.
29. Doyle, Joseph J. 2011. “Returns to Local-Area Healthcare Spending Using Health Shocks to Patients Far from Home.” American Econ. J. Appl. Econ. 3 (3) 221-43.
30. Dranove, David. 1988. “Pricing by Non-profit Institutions The Case of Hospital Cost-Shifting.” J. Health Econ. 7 (1) 47-57.
31. Dranove, David, Craig Garthwaite, and Christopher Ody. 2013. “HowDo Hospitals Respond to Negative Financial Shocks? The Impact of the 2008 Stock Market Crash.” Working Paper no. 18853, NBER, Cambridge, MA.
32. Dunn, Abe, and AdamHale Shapiro. 2014. “Do Physicians Possess Market Power?” J. Law and Econ. 57 (1) 159-93.
33. Fernandez, Bernadette. 2010. “Self-Insured Health Insurance Coverage.” Technical Report no. R41069, Congressional Res. Service, Washington, DC.
34. Finkelstein, Amy. 2004. “Static and Dynamic Effects of Health Policy Evidence from the Vaccine Industry.” Q.J.E. 119 (2) 527-64.
35. Fisher, Elliott S., David E. Wennberg, Thérèse A. Stukel, Daniel J. Gottlieb, F.L. Lucas, and Étoile L. Pinder. 2003. “The Implications of Regional Variations in Medicare Spending.Part 1 The Content, Quality, and Accessibility of Care.” Ann.Internal Medicine 138 (4) 273-87.
36. Fontes, Roger. 2013. “Negotiating Contracts with Insurance Companies.” http//www.hcplive.com/physicians-money-digest/practice-management/Negotiating-Contracts-with-Insurance-Companies-Fontes.
37. Foster, Richard W. 1985. “Cost-Shifting under Cost Reimbursement and Prospective Payment.” J.Health Econ.4 (3) 261-71.
38. Frakt, Austin B. 2011. “How Much Do Hospitals Cost Shift? A Review of the Evidence.” Millbank Q.89 (1) 90-130.
39. Fuchs, Victor R. 2004. “More Variation in Use of Care, More Flat-of-the-Curve Medicine.” Health Affairs 23 (suppl.) VAR-104-VAR-107.
40. Gaynor, Martin, Deborah Haas-Wilson, and William B.Vogt. 2000. “Are Invisible Hands Good Hands? Moral Hazard, Competition, and the Second-Best in Health Care Markets.” J.P.E.108 (5) 992-1005.
41. Gesme, Dean H., and Marian Wiseman. 2010. “How to Negotiate with Health Care Plans.” J.Oncology Practice 6 (4) 220-22.
42. Ginsburg, Paul B., and Robert A. Berenson. 2007. “Revising Medicare’s Physician Fee Schedule—Much Activity, Little Change.” New England J.Medicine 356 1201-3.
43. Glied, Sherry, and Joshua Graff Zivin. 2002. “How Do Doctors Behave When Some (but Not All) of Their Patients Are in Managed Care?” J.Health Econ.21 (2) 337-53.
44. Gonzalez, Martin L., and Puling Zhang, eds. 1998. Physician Marketplace Statistics, 1997/98. Chicago American Medical Assoc.
45. Gowrisankaran, Gautam, Aviv Nevo, and Robert Town. 2013. “Mergers When Prices Are Negotiated Evidence from the Hospital Industry.” Working Paper no.18875, NBER, Cambridge, MA.
46. Gruber, Jonathan, and Robin McKnight. 2014. “Controlling Health Care Costs through Limited Network Insurance Plans Evidence from Massachusetts State Employees.” Working Paper no.20462, NBER, Cambridge, MA.
47. Harvey, Kyle. 2014. “Doctor Networks Opt Out of New Plans.” Visalia Times-Delta, March 14. http//archive.visaliatimesdelta.com/article/20140314/NEWS01/303140002/Doctor-networks-opt-out-new-plans.
48. Ho, Katherine. 2009. “Insurer-Provider Networks in the Medical Care Market.” A.E.R.99:393-430.
49. Jacobson, Mireille, Craig C.Earle, Mary Price, and Joseph P.Newhouse. 2010. “How Medicare’s Payment Cuts for Cancer Chemotherapy Drugs Changed Patterns of Treatment.” Health Affairs 29 (7) 1391-99.
50. Kessler, Daniel P. 2007. “Cost Shifting in California Hospitals What Is the Effect on Private Payers?” California Found.Commerce and Educ., Sacramento. https//www.cornerstone.com/Publications/Research/Cost-Shifting-in-California-Hospitals-What-Is-the.
51. Lewis, Matthew S., and Kevin E.Pflum. 2015. “Diagnosing Hospital System Bargaining Power in Managed Care Networks.” American Econ. J. Econ.Policy 7 (1) 243-71.
52. McGuire, Thomas G., and Mark V.Pauly. 1991. “Physician Response to Fee Changes with Multiple Payers.” J.Health Econ.10 (4) 385-410.
53. Miller, Mark E., Stephen Zuckerman, and Michael Gates. 1993. “How Do Medicare Physician Fees Compare with Private Payers?” Health Care Financing Rev.14 (3) 25-39.
54. Moriya, Asako S., William B.Vogt, and Martin Gaynor.2010. “Hospital Prices and Market Structure in the Hospital and Insurance Industries.” Health Econ., Policy and Law 5 (4) 459-79.
55. Newhouse, Joseph P. 2002. Pricing the Priceless A Health Care Conundrum. Cambridge, MA MIT Press.
56. Nicholson, Sean, and Nicholas S.Souleles. 2001. “Physician Income Expectations and Specialty Choice.” Working Paper no.8536, NBER, Cambridge, MA.
57. Olea, José Luis Montiel, and Carolin Pflueger. 2013. “A Robust Test for Weak Instruments.” J.Bus.and Econ.Statis.31 (3) 358-69.
58. Petterson, Stephen M., Winston R.Liaw, Robert L.Phillips, David L.Rabin, David S.Meyers, and Andrew W.Bazemore. 2012. “Projecting US Primary Care Physician Workforce Needs 2010-2025.” Ann.Family Medicine 10 (6) 503-9.
59. Reckenen, 2013. “How to Negotiate Insurance Contracts.” http//reckenen.com/whitepapers/. Ruggles, Steven, J. Trent Alexander, Katie Genadek, Ronald Goeken, Matthew B.Schroeder, and Matthew Sobek. 2010. “Integrated Public Use Microdata Series Version 5.0.” University of Minnesota.http//usa.ipums.org/.
60. Shiels, John. 2009. “The Cost and Coverage Impacts of a Public Plan.” Lewin Group, Testimony before the Ways and Means Committee, 111th Cong., 1st sess., April 29. https//www.gpo.gov/fdsys/pkg/CHRG-111hhrg52376/html/CHRG-111hhrg52376htm.
61. Showalter, Mark H. 1997. “Physicians’ Cost Shifting Behavior Medicaid versus Other Patients.” Contemporary Econ.Policy 15 (2) 74-84.
62. Skinner, Jonathan S., Douglas O.Staiger, and Elliott S.Fisher. 2006. “Is Technological Change in Medicine Always Worth It? The Case of Acute Myocardial Infarction.” Health Affairs 25 (2) W34-W47.
63. Town, Robert, and Gregory Vistnes. 2001. “Hospital Competition in HMO Networks.” J.Health Econ.20 (5) 733-53.
64. White, Chapin. 2013. “Contrary to Cost-Shift Theory, Lower Medicare Hospital Payment Rates for Inpatient Care Lead to Lower Private Payment Rates.” Health Affairs 32 (5) 935-43.
65. White, Chapin, and Vivian Wu. 2014. “How Do Hospitals Cope with Sustained Slow Growth in Medicare Prices?” Health Services Res.49 (1) 11-31.
66. Wu, Vivian. 2010. “Hospital Cost Shifting Revisited New Evidence from the Balanced Budget Act of 1997.” Internat.J.Health Care Finance and Econ.1061-83.