Physician response to a change in Medicaid fees.

This study examines the effects of a change in Medicaid fees on the volume of physician services provided to beneficiaries. The data set includes price and volume at the procedure-level for Medicaid physician services in Texas in 1991, 1993, and 1995. The empirical analysis compares the volume of services provided to Medicaid participants before and after a 1992 change in reimbursement method. The results indicate that, over the period 1991 to 1993, the change in Texas Medicaid physician fees did not have a statistically significant effect on the volume of services provided. When measured over a longer period of time (1991-1995), however, volume increased significantly when price decreased, but, when price increased, there was no significant effect on volume. The results thus provide empirical support for the behavioural offset assumption underlying the switch to Medicare's Resource-Based Relative Value Scale (RBRVS) method of physician payment. A key policy implication is that reduced fees did not lead to a lower volume of physician services provided to Medicaid patients at least over the period of analysis. However, the new Medicaid fee schedule did not have the desired effect of controlling Medicaid expenditures on physician services.

The effect of rural hospital closures on the financial performance of neighboring rural hospitals.

This study investigates how the closure of rural hospitals affected other rural hospitals. The empirical analysis examined whether being the neighbor of a closed rural hospital affected financial performance variables during the periods before and after closure. Before and after comparisons of surviving rural hospitals were made between 1985 and 1989 for closures in 1987 and between 1986 and 1990 for closures in 1988. The regression results showed that neighbors of closed rural hospitals typically did experience increased volume in comparison to non-neighbors, but the increased volume did not lead to reductions in average cost or to improved profitability, after controlling for other factors.

Antibiotic therapy intervention at a community hospital. Opportunities for cost and quality improvements.

In a one-year study, thirty-two physicians' antibiotic costs decreased significantly and were lower than those in a comparison group. The quality of patient care was not adversely affected, and the hospital's overall rate of nosocomial infection decreased. The success of the program led to its being adopted throughout the hospital. The dynamics of pharmacies' implementing cost-reduction strategies with voluntary medical staffs are discussed throughout the article.

The geographic relationships between physicians' residency sites and the locations of their first practices.

The uneven geographic distribution of physicians has been identified as a significant problem for the delivery of health care services. The present study examined one of the factors that contribute to the distribution of physicians; how far they move from their residency sites to establish their first practices. In 1989, the authors selected a random sample of 701 U.S. residency programs in the ten specialties with the most practitioners, and measured the distance each of these physicians moved to his or her first practice location. Of the 701 programs, 58.5% provided usable information about 2,612 physicians. Of these physicians, over 40% had moved less than 10 miles from their residencies, and over 50% had moved less than 75 miles. Comparisons among the physicians from the various specialties showed that the primary care physicians moved significantly shorter distances than did those from the other specialties. In the last two decades, many efforts have been made to increase the geographic distribution of physicians. The evidence from this study suggests that so far as the distances that physicians move from their practice sites are concerned, little has changed. Recent graduates of residency programs show no more tendency to move far from their residency sites than did their counterparts 30 years ago, as reported in the literature.

Hospital market share: the declining share of small players in the market.

Analysis of a set of isolated hospital markets reveals that low-market-share hospitals have experienced a consistent decline in their market share for the last five years. The challenges presented by such a decline in market share are compounded by the overall decline in the total market (in terms of number of hospital discharges) for the markets studied. It is suggested that significant strategy changes may be required if low-market-share hospitals are to survive.

Physicians' needs for medical specialist support.

This article reports physicians' needs for medical specialists in the hospital care of their patients. Surveyed medical staffs reported a high degree of need for other practitioners of their own specialty and for the traditional hospital-based specialties of radiology and pathology. Cardiologists were selected as the second most important specialty by the respondents. Surgical specialists placed anesthesiologists highest on their lists. Additional analysis of clusters of specialties portrays the greatest similarity of needs for other specialists among family and general practitioners, general surgeons and thoracic surgeons and among endocrinologists and nephrologists.