THE IMPACT OF MARKET COMPETITION ON PHYSICIAN SERVICES

最近医生供应和HMO登记支持的增加 对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。先前关于医生供应与费用和 利用程度不同，产生的结果差别很大。相关研究 医生可获得性与医生的其他重要特征 服务(探视持续时间、护理内容等)已经变得非常 有限，即使这些特征的变化明显会影响 收费与使用相伴变化的政策意义 级别。HMO注册人数的增长如何影响 占主导地位的服务业收费，也极为有限。更多 一般来说，现有和相关研究的价值会因 依赖横截面数据或使用不符合以下条件的合并数据进行估计 充分控制个别地理区域的特点。 在拟议的研究中，将分析1974-1982年期间的数据 为了估计增加的医生供应和 增加医保组织的市场份额。我们将特别研究对以下方面的影响：1) 门诊和住院手术费，2)数量 使用的服务，以及3)提供的门诊护理内容(包括 “初级保健”的组成部分)。主要数据源将包括： 1)Medicare Part-B帐单文件，2)医疗保险协会 美国年度盛行的手术费用表，《健康访谈》 调查和4)全国流动医疗保健调查。池化 时间序列计量技术(例如固定效应和方差 分量估计器)将被应用。 这项研究的结果预计将对联邦政府 影响医生教育和住院医师培训领域的政策， 医生分布、医生付费和卫生保健组织的发展。

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.