THE IMPACT OF MARKET COMPETITION ON PHYSICIAN SERVICES

最近医生供应和HMO注册支持的增加 医生市场竞争加剧的预期 服务 然而，这种竞争加剧的迹象是 不清楚 以前的研究有关医生供应的费用和 利用水平，产生了各种各样的结果。 有关的研究 医生对医生其他重要特征的可用性 服务（探视时间、护理内容等）一直非常 有限，即使这些特征的变化可能会明显影响 费用和使用量的相应变化的政策意义 程度. 研究如何在HMO招生的增长影响 占主导地位的收费服务部门，也极为有限。 更 一般来说，现有的和相关的研究的价值是减少了 依赖横截面数据或合并数据的估计， 充分控制各个地理区域的特征。 在拟议的研究中，将分析1974-1982年期间的数据 估计增加医生供应和 提高了HMO的市场份额。 我们尤其会研究以下方面的影响：1） 门诊和住院手术的费用，2） 所使用的服务，以及3）所提供的门诊护理的内容（包括 “初级保健”的组成部分）。 主要数据来源包括： 1)医疗保险B部分账单文件，2）美国健康保险协会 美国每年流行的手术费用表，3）健康访谈 调查和4）全国门诊医疗服务调查。 合并 时间序列计量经济学技术（如固定效应和方差 成分估计器）将被应用。 这项研究的结果预计将对联邦 影响医生教育和住院医师培训的政策， 医生分配，医生支付和健康维护组织的发展。

Recent increases in the supply of physicians and in HMO enrollment support the expectation of increased competition in the market for physician services. The indications of this increased competition, however, are unclear. Previous research relating physician supply to fees and utilization levels, has produced widely varying results. Research relating physician availability to other important characteristics of physician services (duration of visits, content of care, etc.) has been extremely limited, even though changes in these characteristics could clearly affect the policy significance of concomittant changes in fees and utilization levels. Research on how the growth in HMO enrollment impacts the predominant fee-for service sector, is also extremely limited. More generally, the value of available and relevant studies is diminished by the reliance on cross-sectional data or estimates with pooled data that do not adequately control for the characteristics of individual geographic areas. In the proposed study, data from the period of 1974-1982 will be analyzed to estimate the effect of both the increased physician supply and the increased HMO market share. In particular, we shall examine impact on: 1) fees for ambulatory visits and inpatient surgery, 2) the quantity of services used, and 3) the content of ambulatory care provided (including the components of "primary care"). Principal data sources will include: 1) Medicare Part-B billing files, 2) The Health Insurance Association of America's yearly prevailing surgical fee schedule, 3) The Health Interview Survey and 4) the National Ambulatory Medical Care Survey. Pooled time-series econometric techniques (e.g. fixed-effects and variance component estimators) will be applied. The results of this study are expected to have implications for federal policy in areas affecting physician education and residency training, physician distribution, physician payment and the development of HMO's.