DECADE OF PSYCHIATRY--IMPACT OF COMPETITION

利用最近的一项调查，这里提出了一项新的研究

A new study is proposed here to take advantage of a recent survey of psychiatrists' practice patterns in the mid-1980s. It is hypothesized that mounting competitive forces on both the demand- and supply-sides of the mental health services market have intensified the pressures on psychiatrists' practice patterns and earnings from the late-1970s to the mid-1980s. The specific aims are to compare psychiatrists' economic position over time to that of physicians in other specialties and to document the effect of competition on incomes, fees, work effort, and workloads. The product of this proposed study would be a comprehensive profile of psychiatric practice over nearly a decade, with an emphasis on the effect of competition. This proposal takes advantage of several extensive data bases that have already been assembled: nationally representative samples of psychiatrists surveyed in 1977, 1978, 1979 and 1984-85, by the National Opinion Research Center. These data bases have been enhanced with the addition of secondary data at the state, county, and hospital level. The analytic file is a unique resource with which to study trends in psychiatrists' practice patterns. Descriptive and multivariate analyses will (a) document changes in practice patterns and earnings within the profession; (b) compare the economic status of psychiatrists and other physicians over the past decade; (c) describe the effects of mental health insurance regulation; (d) show the direction and magnitude of changes in psychiatrists' participation in Medicare and Medicaid; (e) examine trends in hospital affiliation; (f) determine the likelihood that a psychiatrist joined an alternate health plan (e.g., HMO, PPO) in the mid-1980s; and (g) assess whether psychiatrists face a more competitive environment than other physicians.