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BMC Health Serv Res ; 21(1): 763, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34340702


BACKGROUND: The structure of the Iranian health system has raised this hypothesis that a part of the Knee Replacement Surgery (KRS) services are provided due to Physician-Induced Demand (PID). METHODS: This paper used an unbalanced individual panel data covering the steady-state 15,729 KRSs performed by 995 surgeons provided by the Armed Forces Insurance Organization at the provincial level over the 60 months (2014-2018). We use a generalized method of moment's system (GMM-SYS) to obtain consistent and asymptotically efficient estimates, which provide a vital instrument for our dynamic panel data. RESULTS: The outcomes show that with unequal increasing orthopedic surgeons to population ratio, both the number and size of KRS services were increased significantly at a 1 % level. Given that the positive elasticity obtained for the service size was significantly larger than the number of services, the findings give strong support for the existence of PID in the Iran system for KRS care. Also, the raw and population-adjusted number of KRS, cost, and the surgery per active physician increased significantly at the monthly province level. CONCLUSIONS: This is the first time that the existence of PID in the Iranian health system is investigated using approved econometric models. The findings indicate that the health system structure has been provided the conditions for aggressive, costly, and high-risk services such as KRS to be exposed to PID.

Artroplastia do Joelho , Cirurgiões , Humanos , Demanda Induzida , Irã (Geográfico)/epidemiologia , Modelos Econométricos
J Health Econ ; 79: 102488, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34284229


This paper empirically investigates how competition affects physicians' opportunistic behavior in the context of the utilization of MRI scanners. We examine micro-panel data on Japanese hospitals, where we observe how physicians change their usage of MRI scanners in response to MRI adoption by nearby hospitals. We identify competition-driven physician-induced demand: Hospitals lose patients because of MRI adoption by nearby hospitals, and, to compensate for this loss, physicians perform more MRI scans per patient. Although competition may benefit consumers through better access to MRI scanners, it also causes additional physician-induced demand.

Demanda Induzida , Médicos , Hospitais , Humanos
Soc Sci Med ; 265: 113511, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33203552


PURPOSE AND SETTING OF RESEARCH: Caesarean section (C-section) rates of over 15% suggest overuse of the surgery which may be difficult to justify on medical grounds. One important contributor to the rise in Csection rates is the rapid expansion of unregulated private-sector providers in number of settings. This study analyses the contribution of private sector in the rapid rise in Csection deliveries in India and the extent to which these can be justified on medical grounds. METHODS: This is a cross sectional study design using National Family Health Surveys. Logistic regression and propensity score matching (PSM) analyses are performed. The main outcome measured is avoidable C-sections in the private sector. PRINCIPAL FINDINGS: Our findings suggest that the rising trend in C-section rates in the private sector cannot be explained by medical reasons alone. The odds of C-section among women who chose to deliver in private was over 4 times higher than women who chose to delivery in public facilities. Despite, controlling for medical complications, women's characteristics and preferences, our PSM analysis suggest that the public-private gap has doubled over the years and that the difference cannot be explained by known determinants of C-section. Over supply of avoidable C-section to the extent of 21%, as a result of physician induced demand and perverse financial incentives was observed in the private sector. CONCLUSIONS: This paper attempts to understand the reason for the high C-section rates in the private sector in India and the extent to which these are avoidable. Our analysis supports the assumption that physician induced demand as a result of perverse financial incentives in the private sector is at play.

Epidemias , Médicos , Cesárea , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Demanda Induzida , Gravidez , Setor Privado
Health Econ ; 29(12): 1566-1585, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32822102


In complex health systems with growing healthcare spending, combining reimbursement systems that incentivize cost-efficient healthcare provision within and across care sectors is key. This study investigates whether dual reimbursement systems lead hospitals to offset financial pressures in one care sector by inducing demand in another. We find that hospital imaging units induced demand for costly and unnecessary ambulatory imaging examinations reimbursed under fee-for-service, following a reform that introduced prospective payment and increased competition in the inpatient sector in Switzerland in 2012. Market structure, competitive pressures, and price regulations also influence demand inducement by varying the response to the reform. Reimbursement systems can influence supplier-induced demand in other care sectors within hospitals where revenue is tied to the intensity of care provision. In particular, the possibility to self-refer patients to high-margin diagnostic examinations bears negative consequences on healthcare expenditures and potentially patient health.

Reforma dos Serviços de Saúde , Demanda Induzida , Diagnóstico por Imagem , Planos de Pagamento por Serviço Prestado , Gastos em Saúde , Humanos