Examining Drivers of Health Care Spending: Evidence on Self-referral Among a Privately Insured Population.
Med Care
; 55(7): 684-692, 2017 07.
Article
en En
| MEDLINE
| ID: mdl-28538332
ABSTRACT
BACKGROUND:
Despite the enactment of laws to restrict the practice of self-referral, exceptions in these prohibitions have enabled these arrangements to persist and proliferate. Most research documenting the effects of self-referral arrangements analyzed claims records from Medicare beneficiaries. Empirical evidence documenting the effects of self-referral on use of services and spending incurred by persons with private insurance is sparse.OBJECTIVES:
We analyzed health insurance claims records from a large private insurer in Texas to evaluate the effects of physician self-referral arrangements involving physical therapy on the treatment of patients with frozen shoulder syndrome, elbow tendinopathy or tendinitis, and patellofemoral pain syndrome. STUDYDESIGN:
We used regression analysis to evaluate the effects of episode self-referral status on (1) initiation of physical therapy; (2) physical therapy visits and services for those who had at least 1 visit; and (3) total condition-related insurer allowed amounts per episode.RESULTS:
For all 3 conditions, we found that patients treated by physician owners were much more likely to be referred for a course of physical therapy when compared with patients seen by physician nonowners. A consistent pattern emerged among patients who had at least 1 physical therapy visit; non-self-referred episodes included more physical therapy visits, and more physical therapy services per episode in comparison with episodes classified as self-referral. Most self-referred episodes were short and the initial visit did not include an evaluation.CONCLUSION:
Physician owners of physical therapy services refer significantly higher percentages of patients to physical therapy and many are equivocal cases.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
Problema de salud:
1_financiamento_saude
/
1_geracao_evidencia_conhecimento
Asunto principal:
Gastos en Salud
/
Sector Privado
/
Auto Remisión del Médico
/
Cobertura del Seguro
Límite:
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Med Care
Año:
2017
Tipo del documento:
Article