THE IMPACT OF PHYSICIAN ECONOMIC INCENTIVES ON ADMISSION RATES OF PATIENTS WITH AMBULATORY SENSITIVE CONDITIONS - AN ANALYSIS COMPARING 2 MANAGED CARE STRUCTURES AND INDEMNITY INSURANCE
Gw. Josephson et A. Karcz, THE IMPACT OF PHYSICIAN ECONOMIC INCENTIVES ON ADMISSION RATES OF PATIENTS WITH AMBULATORY SENSITIVE CONDITIONS - AN ANALYSIS COMPARING 2 MANAGED CARE STRUCTURES AND INDEMNITY INSURANCE, American journal of managed care, 3(1), 1997, pp. 49-56
Citations number
31
Categorie Soggetti
Heath Policy & Services","Medicine, General & Internal
The utilization of financial incentives to limit the use of health res
ources by primary care physicians represents a common reimbursement st
rategy by managed care organizations. These arrangements are virtually
nonexistent with indemnity insurance. This analysis compares the hosp
italization rates of patients with low-acuity medical conditions-ambul
atory sensitive conditions (ASCs)-among three groups receiving care fr
om primary care physicians. The physicians were compensated under diff
erent reimbursement mechanisms, in which incentives for reduced resour
ce utilization varied. The groups can be described as follows: (1) a c
apitated for-profit group practice in which the physician partners hav
e a relatively high economic incentive for lower utilization (group I)
; (2) physicians providing care under the auspices of three separate i
ndependent practice associations, in which the associations are capita
ted but the physicians are paid on a discounted fee-for-service basis
(the associations also were included in this group) (group II); and (3
) physicians who service patients whose care continues to be paid for
by traditional indemnity insurance (group III), Financial incentives i
n the third group cohort were believed to be low to intermediate, and
the physicians were assumed to have had no economic incentives to rest
rain their use of healthcare resources. Additional data analysis exami
ned the role of emergency department utilization among patients in the
groups. Group I patients ages 25 to 44 were admitted for ambulatory s
ensitive conditions at a significantly fewer rate than were patients i
n groups II or 111-0.8/1,000, 2.7/1,000, and 2.9/1,000, respectively,
No difference was apparent in admission rates between patients in grou
ps II and III. Overall emergency department utilization rates were low
est in the group I capitated panel (70/1,000), much higher in the grou
p II independent practice association panel (363/1,000) and highest in
the group III indemnity panel (466/1,000). Each of these rates was si
gnificantly different from the other. Both the ED utilization rate-and
ambulatory sensitive condition admission rate may have been affected
by differences in socioeconomic status among the patient panels in the
three groups. The overall effect of this variable on the two admissio
n rates could not be isolated.