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Financial risk for total health care...

Cooke, Mary H.

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Financial risk for total health care costs: The impact of financial incentives on physician behavior.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Financial risk for total health care costs: The impact of financial incentives on physician behavior./
作者:	Cooke, Mary H.
面頁冊數:	154 p.
附註:	Source: Dissertation Abstracts International, Volume: 75-02(E), Section: B.
Contained By:	Dissertation Abstracts International75-02B(E).
標題:	Health care management. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3601317
ISBN:	9781303521928

Financial risk for total health care costs: The impact of financial incentives on physician behavior.
Cooke, Mary H.

Financial risk for total health care costs: The impact of financial incentives on physician behavior. - 154 p.

Source: Dissertation Abstracts International, Volume: 75-02(E), Section: B.

Thesis (D.H.A.)--Central Michigan University, 2013.

Episodic and volume-driven health care delivery and reimbursement systems directly contribute to suboptimal health outcomes and unsustainable U.S. health care cost trends. The economic incentives inherent in differing payment methodologies and their impact on health outcomes and utilization are widely studied. Little is known about the joint influence that practice-level contextual enabling factors have on provider behavior, and ultimately health outcomes and utilization. Financial risk influences decisions about infrastructure investments &Dot;C resources and enabling factors that can restrain or promote provider-controlled consumption of health care services. Because these factors are more challenging to identify and measure, they are less rigorously studied. This study expands upon the current literature by investigating the association between financial incentives at the medical practice level, resulting administrative changes to the operating environment, and provider practice patterns. The purpose of this study is twofold: to determine whether a change in the financial risk profile of a medical practice influences physician behavior and leads to changes in physician-enabled health care consumption at a single major academic medical center, and to determine whether the elimination of restraint-promoting enabling resources similarly impacts consumption patterns of a cohort of enrolled managed care members at that Center. Provider-driven utilization rates are used as a proxy for analyzing physician behavior patterns in response to system-level financial and contextual changes. Observed changes in utilization under varying payment schemes may more accurately result from the combined influences of financial risk and enabling factors in the operating environment. Administrative claims data are used to analyze pharmacy, urgent care, specialty, inpatient, and primary care utilization patterns over a three year period. This study utilizes a stratified analysis to control for potential confounding by patient characteristics and account for correlation among repeated observations as is common in longitudinal studies. Using a conditional logistic regression model I compare pre-intervention with post-intervention patient stratum health care consumption, with each outcome variable corresponding to a monthly indicator of whether a unit of service was obtained for a particular patient. I then combine comparisons into an overall odds ratio estimate, 95% confidence interval, and with statistical significance indicated by a p-value ¡U 0.05. Findings for each of the outcome variables suggest that changes to financial risk and changes to contextual enabling resources are associated with a significant impact on health care consumption patterns. Given that current financial incentives largely favor intervention over restraint, physicians in a medical practice context are likely to draw upon readily available resources when making discretionary clinical decisions about what services to provide to their patients. Enabling resources are structured to either raise or lower the threshold for utilization, depending on the business model they are designed to support. While this evaluation provides evidence of the utility of including changes to contextual enabling resources when analyzing the impact of financial incentives on physician-enabled utilization, further evaluation of varying enabling resources should be conducted to determine whether some factors have more impact on consumption than others and under what circumstances.

ISBN: 9781303521928Subjects--Topical Terms:

2122906
Health care management.

Financial risk for total health care costs: The impact of financial incentives on physician behavior.
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