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The United States physician services market: Price competition, bargaining power, and the effects of physician-managed care market structure.

机译：美国医师服务市场：价格竞争，议价能力以及医师管理的护理市场结构的影响。

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摘要

Recent U.S. health care system changes have raised concerns about their competitive effects. For the physician services market, economic theory supports contradictory results, and limited previous evidence does not reflect managed care reimbursement and the recent changes. This study contributes an approach for estimating market structure competitive effects using a physician-managed care insurer bargaining model. It also addresses a gap in the industrial organization literature on bilateral market power by explicitly considering buyer and seller market structure-market power effects. Indeterminate theoretical competitive effects yield testable hypotheses of whether a change in physician (seller) versus managed care (buyer) market power dominates. New data on 1997 market structure characteristics and commercial managed care fees for primary care and specialist services are used to estimate a simultaneous equations model for managed care (bargained) and non-bargained price-cost mark-ups. Explanatory variables represent managed care penetration and concentration, physician horizontal and vertical integration, physician supply competition, and the regulatory environment, with metropolitan statistical areas as the geographic market definition.;The findings include substantial physician market power in the absence of managed care bargaining power (43 percent Lerner index price mark-up), and approximately equal physician and managed care relative bargaining power. Physician market and relative bargaining power vary between primary care and specialist services, with greater market power and less bargaining power for specialist services. Managed care bargaining power substantially increases physician price competition, reducing non-bargained mark-ups by 46 percent; 56 percent in markets with high HMO penetration. Market characteristics significantly increasing managed care bargaining power and physician price competition included total and Medicare HMO penetration, physician vertical integration with hospitals and HMOs, and the proportion of international medical graduates. Anti-competitive effects were found for HMO and physician concentration, the percent uninsured, and restrictive state managed care regulations. The findings imply that policies affecting U.S. physician-managed care market structure impact price competition, which may hold for other medical care markets where third-party insurance is a major payment source. Policymakers can use this information to foster a more competitive medical services environment.
机译：美国最近的医疗保健制度变化引起了人们对其竞争效果的担忧。对于医师服务市场，经济学理论支持矛盾的结果，有限的先前证据不能反映管理式医疗报销和最近的变化。这项研究提供了一种使用医师管理的医疗保险公司议价模型来估计市场结构竞争效应的方法。它还通过明确考虑买卖双方的市场结构-市场力量效应，解决了工业组织有关双边市场力量的文献中的空白。不确定的理论竞争效应产生了可验证的假设，即医师（卖方）与管理式照护（买方）市场力量的变化是否占主导地位。使用有关1997年市场结构特征的新数据以及初级保健和专科服务的商业管理式护理费用来估计管理式护理（议价）和非议价价格-成本加价的联立方程模型。解释性变量代表管理式医疗的渗透和集中度，医生的横向和纵向整合，医生的供应竞争以及监管环境，以大都市统计区域作为地理市场定义。;研究结果包括在没有管理式医疗议价能力的情况下的实质性医生市场力量（Lerner指数价格上涨了43％），并且医生和管理式护理的相对议价能力大致相等。初级保健和专科服务之间医师市场和相对议价能力各不相同，其中专科服务的市场力量更大，议价能力更低。管理式医疗议价能力大大提高了医师的价格竞争能力，使非议价加价幅度降低了46％； HMO渗透率高的市场中有56％。市场特征显着提高了管理式医疗的讨价还价能力和医师价格竞争，包括总和Medicare HMO渗透率，医师与医院和HMO的垂直整合以及国际医学毕业生的比例。发现对HMO和医生的浓度，未投保的百分比以及州管理性护理法规的限制产生了竞争影响。研究结果表明，影响美国医师管理的护理市场结构的政策会影响价格竞争，这可能对以第三方保险为主要支付来源的其他医疗市场有效。政策制定者可以使用此信息来营造更具竞争力的医疗服务环境。

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  • 作者

    Snyder, Susan Rose.;

  • 作者单位

    Georgia State University.;

  • 授予单位 Georgia State University.;
  • 学科 Economics Commerce-Business.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2001
  • 页码 197 p.
  • 总页数 197
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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