Hospital-Physician Integration: Causes and Consequences for Rural Communities and Physician Wage Gaps in Primary and Specialty Care

项目摘要 医院正在迅速获得实践和雇用医生在医院的浪潮- 医生整合。现在有超过50%的人在医院工作，而2002年只有20%。 一些观察家认为这种“垂直整合”的兴起是一种积极的发展，因为它 提高协调和减少浪费的潜力。其他人认为，供应商整合是为了 反竞争的原因，指出价格和支出飙升超过10%， 对初级保健医生和专家之间收入差距扩大的关切，以及 推测这可能会加剧农村和城市社区之间的差距。尽管 人们对这些问题、纵向一体化的原因和后果仍然知之甚少。 本研究的目的是将计量经济学、准实验设计和 将各种重要数据来源联系起来，以评价一体化对收入的影响 城乡社区初级保健医生和专家之间的差距。这 这项研究将使用来自美国人口普查的罕见收入数据，以及医疗保险索赔和其他 健康研究数据库，以测试医生质量或财务指标是否推动整合 这些因素是否因农村和城市环境而异。它将进一步考验 一体化是否会导致初级保健和专家收入的分离， 农村社区的监管环境和劳动力市场结构改变了这一点 工资差距我们将使用大型回顾性数据集、纵向计量经济学技术， 工具变量分析来研究这些问题。我们希望能找到 激励措施比医生质量更能解释一体化， 社区的融合程度低于城市，而这种融合会提高社区居民的收入， 与初级保健相关的专家。该项目的结果将增强证据基础 医疗保险，商业支付者和监管机构需要设计一个政策响应， 纵向一体化带来的后果和机会。

Project Summary Hospitals are rapidly acquiring practices and employing physicians in a wave of hospital- physician integration. Over 50 percent now work for hospitals, up from 20 percent in 2002. Some observers view this rise of “vertical integration” as a positive development because of its potential to improve coordination and reduce waste. Others argue that providers integrate for anti-competitive reasons, pointing to price and spending spikes of more than 10 percent, raising concerns about widening income gaps between primary care physicians and specialists, and speculating that it may exacerbate disparities between rural and urban communities. Despite these concerns, the causes and consequences of vertical integration remain poorly understood. The objective of this study is to bring together econometrics, quasi-experimental design, and linkages of a wide array of critical data sources to evaluate the effects of integration on income gaps between primary care physician and specialists across urban and rural communities. This study will use rare income data from the U.S. Census, paired with Medicare claims and other health research databases, to test whether physician quality or financial metrics drive integration with hospitals, and whether these factors differ by rural and urban setting. It will further test whether integration drives apart primary care and specialist incomes, and whether the different regulatory environment and labor market structure found in rural communities modifies this wage gap. We will use a large retrospective dataset, longitudinal econometric techniques, and instrumental variables analysis to examine these issues. We expect to find that financial incentives are a stronger explanation for integration than physician quality, that rural communities integrate less than urban ones, and that integration drives up the incomes of specialists relative to primary care. Results from this project will enhance the evidence base needed by Medicare, commercial payers, and regulators to design a policy response to the consequences of – and opportunities presented by – vertical integration.