The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Darius N Lakdawalla - One of the best experts on this subject based on the ideXlab platform.
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healing the poor the influence of patient socioeconomic status on Physician Supply responses
Journal of Health Economics, 2019Co-Authors: Alice Chen, Darius N LakdawallaAbstract:Abstract A longstanding literature explores how altruism affects the way Physicians respond to incentives and provide care. We analyze how patient socioeconomic status mediates these responses. We show theoretically that patient socioeconomic status systematically influences the way Physicians respond to reimbursement changes, and we identify the channels through which these effects operate. We use two Medicare reimbursement changes to investigate these insights empirically. We confirm that a given Physician facing an increase in reimbursement boosts utilization by more when treating richer patients. We show that average Supply price elasticities vary from 0.02 to 0.18 for a given Physician, depending on the patient’s socioeconomic status. Finally, we show that the Medicare reforms we study led to overall reimbursement increases that raised healthcare utilization by 10% more for high-income patients compared to their low-income peers.
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healing the poor the influence of patient socioeconomic status on Physician Supply responses
Social Science Research Network, 2016Co-Authors: Alice Chen, Darius N LakdawallaAbstract:A longstanding literature has highlighted the tension between the altruism of Physicians and their desire for profit. This paper develops new implications for how these competing forces drive pricing and utilization in healthcare markets. Altruism dictates that providers reduce utilization in response to higher prices, but profit-maximization does the opposite. Rational Physicians will behave more altruistically when treating poorer patients or those that face higher medical cost burdens, and when foregone profits are lower. These insights help explain the observed heterogeneity in pricing dynamics across different healthcare markets. We empirically test the implications of our model by utilizing two exogenous shocks in Medicare price setting policies. Our results indicate that patient income, out-of-pocket costs, and profitability alone explain up to one-quarter of the variation in price elasticities. Finally, we demonstrate that uniform policy changes in reimbursement or patient cost-sharing may lead to unintended consequences.
Rie Sakai - One of the best experts on this subject based on the ideXlab platform.
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evaluating the effect of japan s 2004 postgraduate training programme on the spatial distribution of Physicians
Human Resources for Health, 2015Co-Authors: Rie Sakai, Hiroshi Tamura, Rei Goto, Ichiro KawachiAbstract:Background: In 2004, the Japanese government permitted medical graduates for the first time to choose their training location directly through a national matching system. While the reform has had a major impact on Physicians’ placement, research on the impact of the new system on Physician distribution in Japan has been limited. In this study, we sought to examine the determinants of Physicians’ practice location choice, as well as factors influencing their geographic distribution before and after the launch of Japan’s 2004 postgraduate medical training programme. Methods: We analyzed secondary data. The dependent variable was the change in Physician Supply at the secondary tier of medical care in Japan, a level which is roughly comparable to a Hospital Service Area in the US. Physicians were categorized into two groups according to the institutions where they practiced; specifically, hospitals and clinics. We considered the following predictors of Physician Supply: ratio of Physicians per 1,000 population (Physician density), age-adjusted mortality, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Results: Baseline Physician density showed a positive association with the change in Physician Supply after the launch of the 2004 programme (P-value < .001), whereas no such effect was found before 2004. Urban locations were inversely associated with the change in Physician Supply before 2004 (P-value = .026), whereas a positive association was found after 2004 (P-value < .001). Urban location and area-level socioeconomic status were positively correlated with the change in hospital Physician Supply after 2004 (P-values < .001 for urban centre, and .025 for area-level socioeconomic status), even though in the period prior to the 2004 training scheme, urban location was inversely associated with the change in Physician Supply (P-value = .015) and area-level socioeconomic status was not correlated. Conclusion: Following the introduction of the 2004 postgraduate training programme, Physicians in Japan were more likely to move to areas with already high Physician density and urban locations. These changes worsened regional inequality in Physician Supply, particularly hospital doctors.
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evaluating the effect of japan s 2004 postgraduate training programme on the spatial distribution of Physicians
Human Resources for Health, 2015Co-Authors: Rie Sakai, Hiroshi Tamura, Rei Goto, Ichiro KawachiAbstract:In 2004, the Japanese government permitted medical graduates for the first time to choose their training location directly through a national matching system. While the reform has had a major impact on Physicians’ placement, research on the impact of the new system on Physician distribution in Japan has been limited. In this study, we sought to examine the determinants of Physicians’ practice location choice, as well as factors influencing their geographic distribution before and after the launch of Japan’s 2004 postgraduate medical training programme. We analyzed secondary data. The dependent variable was the change in Physician Supply at the secondary tier of medical care in Japan, a level which is roughly comparable to a Hospital Service Area in the US. Physicians were categorized into two groups according to the institutions where they practiced; specifically, hospitals and clinics. We considered the following predictors of Physician Supply: ratio of Physicians per 1,000 population (Physician density), age-adjusted mortality, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Baseline Physician density showed a positive association with the change in Physician Supply after the launch of the 2004 programme (P-value < .001), whereas no such effect was found before 2004. Urban locations were inversely associated with the change in Physician Supply before 2004 (P-value = .026), whereas a positive association was found after 2004 (P-value < .001). Urban location and area-level socioeconomic status were positively correlated with the change in hospital Physician Supply after 2004 (P-values < .001 for urban centre, and .025 for area-level socioeconomic status), even though in the period prior to the 2004 training scheme, urban location was inversely associated with the change in Physician Supply (P-value = .015) and area-level socioeconomic status was not correlated. Following the introduction of the 2004 postgraduate training programme, Physicians in Japan were more likely to move to areas with already high Physician density and urban locations. These changes worsened regional inequality in Physician Supply, particularly hospital doctors.
Ichiro Kawachi - One of the best experts on this subject based on the ideXlab platform.
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evaluating the effect of japan s 2004 postgraduate training programme on the spatial distribution of Physicians
Human Resources for Health, 2015Co-Authors: Rie Sakai, Hiroshi Tamura, Rei Goto, Ichiro KawachiAbstract:Background: In 2004, the Japanese government permitted medical graduates for the first time to choose their training location directly through a national matching system. While the reform has had a major impact on Physicians’ placement, research on the impact of the new system on Physician distribution in Japan has been limited. In this study, we sought to examine the determinants of Physicians’ practice location choice, as well as factors influencing their geographic distribution before and after the launch of Japan’s 2004 postgraduate medical training programme. Methods: We analyzed secondary data. The dependent variable was the change in Physician Supply at the secondary tier of medical care in Japan, a level which is roughly comparable to a Hospital Service Area in the US. Physicians were categorized into two groups according to the institutions where they practiced; specifically, hospitals and clinics. We considered the following predictors of Physician Supply: ratio of Physicians per 1,000 population (Physician density), age-adjusted mortality, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Results: Baseline Physician density showed a positive association with the change in Physician Supply after the launch of the 2004 programme (P-value < .001), whereas no such effect was found before 2004. Urban locations were inversely associated with the change in Physician Supply before 2004 (P-value = .026), whereas a positive association was found after 2004 (P-value < .001). Urban location and area-level socioeconomic status were positively correlated with the change in hospital Physician Supply after 2004 (P-values < .001 for urban centre, and .025 for area-level socioeconomic status), even though in the period prior to the 2004 training scheme, urban location was inversely associated with the change in Physician Supply (P-value = .015) and area-level socioeconomic status was not correlated. Conclusion: Following the introduction of the 2004 postgraduate training programme, Physicians in Japan were more likely to move to areas with already high Physician density and urban locations. These changes worsened regional inequality in Physician Supply, particularly hospital doctors.
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evaluating the effect of japan s 2004 postgraduate training programme on the spatial distribution of Physicians
Human Resources for Health, 2015Co-Authors: Rie Sakai, Hiroshi Tamura, Rei Goto, Ichiro KawachiAbstract:In 2004, the Japanese government permitted medical graduates for the first time to choose their training location directly through a national matching system. While the reform has had a major impact on Physicians’ placement, research on the impact of the new system on Physician distribution in Japan has been limited. In this study, we sought to examine the determinants of Physicians’ practice location choice, as well as factors influencing their geographic distribution before and after the launch of Japan’s 2004 postgraduate medical training programme. We analyzed secondary data. The dependent variable was the change in Physician Supply at the secondary tier of medical care in Japan, a level which is roughly comparable to a Hospital Service Area in the US. Physicians were categorized into two groups according to the institutions where they practiced; specifically, hospitals and clinics. We considered the following predictors of Physician Supply: ratio of Physicians per 1,000 population (Physician density), age-adjusted mortality, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Baseline Physician density showed a positive association with the change in Physician Supply after the launch of the 2004 programme (P-value < .001), whereas no such effect was found before 2004. Urban locations were inversely associated with the change in Physician Supply before 2004 (P-value = .026), whereas a positive association was found after 2004 (P-value < .001). Urban location and area-level socioeconomic status were positively correlated with the change in hospital Physician Supply after 2004 (P-values < .001 for urban centre, and .025 for area-level socioeconomic status), even though in the period prior to the 2004 training scheme, urban location was inversely associated with the change in Physician Supply (P-value = .015) and area-level socioeconomic status was not correlated. Following the introduction of the 2004 postgraduate training programme, Physicians in Japan were more likely to move to areas with already high Physician density and urban locations. These changes worsened regional inequality in Physician Supply, particularly hospital doctors.
Leiyu Shi - One of the best experts on this subject based on the ideXlab platform.
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quantifying the health benefits of primary care Physician Supply in the united states
International Journal of Health Services, 2007Co-Authors: James Macinko, Barbara Starfield, Leiyu ShiAbstract:This analysis addresses the question, Would increasing the number of primary care Physicians improve health outcomes in the United States? A search of the PubMed database for articles containing “primary care Physician Supply” or “primary care Supply” in the title, published between 1985 and 2005, identified 17 studies, and 10 met all inclusion criteria. Results were reanalyzed to assess primary care effect size and the predicted effect on health outcomes of a one-unit increase in primary care Physicians per 10,000 population. Primary care Physician Supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year (1980–1995) or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care Physician per 10,000 population was associ...
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Quantifying the health benefits of primary care Physician Supply in the United States.
International journal of health services : planning administration evaluation, 2007Co-Authors: James Macinko, Barbara Starfield, Leiyu ShiAbstract:This analysis addresses the question, Would increasing the number of primary care Physicians improve health outcomes in the United States? A search of the PubMed database for articles containing "primary care Physician Supply" or "primary care Supply" in the title, published between 1985 and 2005, identified 17 studies, and 10 met all inclusion criteria. Results were reanalyzed to assess primary care effect size and the predicted effect on health outcomes of a one-unit increase in primary care Physicians per 10,000 population. Primary care Physician Supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year (1980-1995) or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care Physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year.
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is primary care effective quantifying the health benefits of primary care Physician Supply in the united states
2007Co-Authors: James Macinko, Barbara Starfield, Leiyu ShiAbstract:This analysis addresses the question, Would increasing the number of primary care Physicians improve health outcomes in the United States? A search of the PubMed database for articles containing “primary care Physician Supply” or “primary care Supply” in the title, published between 1985 and 2005, identified 17 studies, and 10 met all inclusion criteria. Results were reanalyzed to assess primary care effect size and the predicted effect on health outcomes of a one-unit increase in primary care Physicians per 10,000 population. Primary care Physician Supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year (1980–1995) or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care Physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year.
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the effect of primary care Physician Supply and income inequality on mortality among blacks and whites in us metropolitan areas
American Journal of Public Health, 2001Co-Authors: Leiyu Shi, Barbara StarfieldAbstract:Objectives. This study assessed whether income inequality and primary care Physician Supply have a different effect on mortality among Blacks compared with Whites. Methods.We conducted a multivariate ecologic analysis of 1990 data from 273 US metropolitan areas. Results. Both income inequality and primary care Physician Supply were significantly associated with White mortality (P .10), particularly in areas with high income inequality. Conclusions. Improvement in population health requires addressing socioeconomic determinants of health, including income inequality and primary care availability and access.
Bernard S Black - One of the best experts on this subject based on the ideXlab platform.
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fictions and facts medical malpractice litigation Physician Supply and health care spending in texas before and after hb 4
Social Science Research Network, 2019Co-Authors: Charles Silver, David A Hyman, Bernard S BlackAbstract:This article, written for a symposium issue of the Texas Tech Law Review, summarizes our research on the impact of Texas’ 2003 medical malpractice (“med mal”) reform. Our central findings include: (1) there were no major changes in the frequency of med mal claims, payout per claim, total payouts, defense costs, or jury verdicts that can explain the spike in premiums for med mal liability insurance that occurred in Texas in the years before the 2003 reforms; (2) Texas’ Supply of direct patient care Physicians grew steadily, at similar rates, in both the pre- and post-reform periods, despite politician’s claims that Physicians fled Texas before reform and flocked back thereafter; (3) although the damage caps adopted in Texas and other states greatly reduced the volume of malpractice litigation and payouts to patients, neither in Texas nor in other states have damage caps moderated the growth of health care spending; (4) the savings in liability costs generated by the Texas reforms were shared between Physicians and their insurers, with the former paying lower premiums and the latter collecting more premium dollars relative to dollars paid out on claims; and (5) there is evidence that when liability rules are relaxed, hospital safety records gradually deteriorate.
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does tort reform affect Physician Supply evidence from texas
International Review of Law and Economics, 2015Co-Authors: David A Hyman, Charles Silver, Bernard S Black, Myungho PaikAbstract:Abstract Does state tort reform affect Physician Supply? Tort reformers certainly believe so. Before Texas adopted tort reform in 2003, proponents claimed that Physicians were deserting Texas in droves. After tort reform was enacted, proponents claimed there had been a dramatic increase in Physicians moving to Texas due to the improved liability climate. We find no evidence to support either claim. Physician Supply was not measurably stunted prior to reform, and it did not measurably improve after reform. This is true for all patient care Physicians in Texas, high-malpractice-risk specialties, primary care Physicians, and rural Physicians.
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the impact of the 2003 texas medical malpractice damages cap on Physician Supply and insurer payouts separating facts from rhetoric
Social Science Research Network, 2008Co-Authors: Charles Silver, David A Hyman, Bernard S BlackAbstract:In 2003, Texas adopted House Bill 4 ("HB 4") which capped non-economic damages in medical malpractice cases and included several other smaller reforms. To proponents, HB 4 is a silver bullet, encouraging Physicians to move to Texas by reducing frivolous lawsuits, preventing excessive damage awards by run-away juries, and reducing malpractice insurance premiums. To critics, it is ineffective (because it will neither materially increase the number of Physicians, lower malpractice premiums, nor reduce health care costs) and unfair (because it forces injured patients to accept inadequate compensation and hits plaintiffs who are severely injured, women, children, or elderly especially hard). In this short paper, prepared for a special issue on the effects of HB 4, we present new evidence of its effect on the number of Physicians in Texas. There is, as yet, no evidence that HB 4 increased the number of Physicians involved in direct patient care, but some evidence consistent with a delayed effect. There may have been a modest increase in the number of specialists engaged in direct patient care, in line with population growth. We also summarize our findings from a previous article on how the damages cap will affect payouts. We estimate that, if the same cases were brought, the cap would result in an18-25% drop in per-case payouts in settled cases, and a 27% drop in tried cases. We also find that a cap on non-economic damages will have different effects on different groups of plaintiffs, with larger effects on the unemployed and deceased, and likely on the elderly as well. Because one would expect the cap to dissuade some plaintiffs from suing at all, especially those in the more severely affected groups, the cap's effect on insurers' costs -- and thus its long-run effect on malpractice insurance premiums -- will likely exceed our per-case estimates.