Physician Practice Organization and Negotiated Prices: Evidence from State Law Changes

2021 ◽  
Vol 13 (2) ◽  
pp. 258-296
Author(s):  
Naomi Hausman ◽  
Kurt Lavetti
Keyword(s):  
Economies Of Scale ◽  
State Level ◽  
Organizational Structures ◽  
Physician Practice ◽  
Fixed Costs ◽  
State Law ◽  
Practice Organization ◽  
Percent Increase ◽  
Noncompete Agreements ◽  
The Relationship

We study the relationship between physician organizational structures and prices negotiated with private insurers. Using variation caused by state-level judicial law changes, we show that a 10 percent increase in the enforceability of noncompete agreements (NCAs) causes 4.3 percent higher physician prices, and declines in practice sizes and concentration. Using two databases containing every physician establishment and firm between 1996 and 2007, linked to negotiated prices, we show that larger practices have lower prices for services with high fixed costs, consistent with economies of scale. In contrast, increases in firm concentration conditional on establishment concentration leads to higher prices. (JEL D24, G22, I11, J44, K22, L13)

Cohort, Gender and Practice Organization: Examining the Bounds of Collaborative Medicine among Newly Established Female and Male Family Physicians in Ontario

1997 ◽  
Vol 10 (1-2) ◽  
pp. 121-131 ◽  
Author(s):  
A. P. Williams ◽  
C. A. Woodward ◽  
B. Ferrier ◽  
M. Cohen
Keyword(s):  
Economies Of Scale ◽  
Family Physicians ◽  
Peer Collaboration ◽  
Women Physicians ◽  
Group Practice ◽  
Community Based ◽  
Solo Practice ◽  
Practice Organization ◽  
And Gender ◽  
The Relationship

This paper analyzes data from a 1993 survey of 395 newly established female and male family physicians in Ontario, Canada, to examine the relationship between practice organization and gender. Previous research suggests that younger physicians, particularly women, tend to enter group practice. Compared to solo practice, groups may offer more predictable incomes, more manageable workloads, peer collaboration and review, and economies of scale. Further, female physicians in groups may develop distinctive styles of collaborative medicine. The results show that a majority of physicians in our cohort are in private community-based group practice. However, while many groups share premises, staff and expenses, and many have common charts and practice guidelines, only a minority incorporate regular meetings to discuss business or patient care, have shared care of hospitalized patients, or audits of physicians' practices. Few gender differences are observed in private group practice: although women physicians attract larger proportions of female patients than do their male colleagues, women and men organize their groups in similar ways and have similarly strong patient-centred attitudes.

Characterizing Physician Practice in Nursing Homes Using Claims-Based Measures: Correlation With Nursing Home Administrators’ Perceptions

2020 ◽  
pp. 107755872096090
Author(s):  
Kira L. Ryskina ◽  
Wei Song ◽  
Vaishnavi Sharma ◽  
Yihao Yuan ◽  
Orna Intrator
Keyword(s):  
Nursing Homes ◽  
Administrator Perceptions ◽  
Physician Practice ◽  
Fee For Service ◽  
Term Care ◽  
Nursing Home Administrators ◽  
Physician Participation ◽  
Practice Organization ◽  
The Relationship

Heterogeneity in physician practice within nursing homes (NHs) may explain variations in quality. However, data on physician practice organization in NHs are hard to obtain. We characterized NH physician practice using two claims-based measures: (a) concentration of NH care among physicians (measured by Herfindahl–Hirschman index of visits); and (b) physician NH practice specialization (measured by the proportion of a physician’s visits to NHs). We examined the relationship between the measures and NH administrator perceptions of physician practice reported in the Shaping Long-Term Care in America (SLTCA) Survey. All 2011 Part B claims from 13,718 physicians who treated Medicare fee-for-service patients in 2,095 NHs in the SLTCA survey were analyzed. The median Herfindahl–Hirschman index was 0.44 (interquartile range [IQR] 0.28-0.70), and the median specialization was 38.1% (IQR 19.9% to 60.9%). NHs with higher physician specialization reported more frequent physician participation in care coordination activities. Claims-based measures could inform the study of NH physician practice.

Increasing Productivity Of Vegetables Through Front-line Demonstrations

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
R. S. Suman
Keyword(s):  
Agricultural Practices ◽  
Front Line ◽  
Rainfed Condition ◽  
Percent Increase ◽  
Recommended Practices ◽  
High Yielding Varieties ◽  
Climate Parameter ◽  
Sustainable Agricultural Practices ◽  
The Relationship

The highest yield (420 kg/ha) was recorded in the year 2011-12. In Front-Line Demonstration, it was 27.27 percent more over the farmers practice (320 kg/ha), however, the lowest yield (350 kg/ha) was recorded in the year 2010-11 under Front-Line Demonstration and 310 kg/ha in farmers' practice. Increase in the yield (27.27%) under Front-Line Demonstration over farmers practice was obtained during the year 2011-12. The variation in the percent increase in the yield was found due to variation in agro climate parameter under rainfed condition. Under sustainable agricultural practices, with this study it is concluded that the Front- LineDemonstration programme was effective in changing attitude, skill and knowledge of improved / recommended practices of High Yielding Varieties of peas included adoption. This also improved the relationship between farmers and scientist and built confidence between them.

The Working Sheep Dog as a Model of the Street- Level Public Servant

Public Voices ◽  
2017 ◽  
Vol 6 (1) ◽  
pp. 51
Author(s):  
Anne J. Hacker
Keyword(s):  
Organizational Structures ◽  
Servant Leader ◽  
Street Level ◽  
Public Servant ◽  
The Relationship

There are examples all around us of natural, simple, yet amazingly complex organizational structures that demonstrate models of leadership that are of use today. The working sheep dog is one such example. It is a vision of grace, ability, stamina and integrity. The relationship that exists between theses canine and human partners mirrors that of the street-level public servant and servant leader.

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

2021 ◽  
pp. 1357633X2098277
Author(s):  
Molly Jacobs ◽  
Patrick M Briley ◽  
Heather Harris Wright ◽  
Charles Ellis
Keyword(s):  
Cost Effectiveness ◽  
Economies Of Scale ◽  
Reference Group ◽  
Unit Cost ◽  
Community Based ◽  
Face To Face ◽  
Conduction Aphasia ◽  
Aphasia Treatment ◽  
The Cost ◽  
The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

Changing the Composition of Beginning Teachers: The Role of State Alternative Certification Policies

2021 ◽  
pp. 089590482110156
Author(s):  
Christopher Redding
Keyword(s):  
Beginning Teachers ◽  
Alternative Certification ◽  
New Teachers ◽  
State Level ◽  
Schools And Staffing Survey ◽  
Selective Colleges ◽  
Nationally Representative ◽  
Alternate Routes ◽  
The Relationship

Drawing on nationally representative data from six cohorts of beginning teachers from the Schools and Staffing Survey and the National Teacher and Principal Survey, this study applies a difference-in-differences research design to examine the relationship between changes to state-level alternative certification policies and the characteristics of new teachers. The introduction of alternate routes into teaching is associated with an increase in the fraction of new teachers of color in a state and the new teachers who graduated from selective colleges. No evidence was found of a relationship with the relative share of male teachers or teachers of in-demand subjects.

When Religion Hurts: Structural Sexism and Health in Religious Congregations

2021 ◽  
pp. 000312242199668
Author(s):  
Patricia Homan ◽  
Amy Burdette
Keyword(s):  
General Social Survey ◽  
State Level ◽  
Religious Participation ◽  
Religious Institutions ◽  
Religious Congregations ◽  
Positive Health ◽  
Nationally Representative ◽  
Positive Health Outcomes ◽  
High Degree ◽  
The Relationship

An emerging line of research has begun to document the relationship between structural sexism and health. This work shows that structural sexism—defined as systematic gender inequality in power and resources—within U.S. state-level institutions and within marriages can shape individuals’ physical health. In the present study, we use a novel dataset created by linking two nationally representative surveys (the General Social Survey and the National Congregations Study) to explore the health consequences of structural sexism within another setting: religious institutions. Although religious participation is generally associated with positive health outcomes, many religious institutions create and reinforce a high degree of structural sexism, which is harmful for health. Prior research has not reconciled these seemingly conflicting patterns. We find that among religious participants, women who attend sexist religious institutions report significantly worse self-rated health than do those who attend more inclusive congregations. Furthermore, only women who attend inclusive religious institutions exhibit a health advantage relative to non-participants. We observe marginal to no statistically significant effects among men. Our results suggest the health benefits of religious participation do not extend to groups that are systematically excluded from power and status within their religious institutions.

Trust in Government and the American Public’s Responsiveness to Rising Inequality

2019 ◽  
Vol 73 (4) ◽  
pp. 790-804 ◽  
Author(s):  
David Macdonald
Keyword(s):  
United States ◽  
Public Opinion ◽  
Income Inequality ◽  
State Level ◽  
Political Trust ◽  
The United States ◽  
Trust In Government ◽  
Combine Data ◽  
Election Studies ◽  
The Relationship

The United States has become increasingly unequal. Income inequality has risen dramatically since the 1970s, yet public opinion toward redistribution has remained largely unchanged. This is puzzling, given Americans’ professed concern regarding, and knowledge of, rising inequality. I argue that trust in government can help to reconcile this. I combine data on state-level income inequality with survey data from the Cumulative American National Election Studies (CANES) from 1984 to 2016. I find that trust in government conditions the relationship between inequality and redistribution, with higher inequality prompting demand for government redistribution, but only among politically trustful individuals. This holds among conservatives and non-conservatives and among the affluent and non-affluent. These findings underscore the relevance of political trust in shaping attitudes toward inequality and economic redistribution and contribute to our understanding of why American public opinion has not turned in favor of redistribution during an era of rising income inequality.

State-Level Sexism and Women’s Health Care Access in the United States: Differences by Race/Ethnicity, 2014–2019

2021 ◽  
pp. e1-e10
Author(s):  
Kristen Schorpp Rapp ◽  
Vanessa V. Volpe ◽  
Hannah Neukrug
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Hispanic Women ◽  
State Level ◽  
The United States ◽  
Barriers To Health Care ◽  
Care Access ◽  
Race Ethnicity ◽  
The Relationship ◽  
Barriers To Health

Objectives. To quantify racial/ethnic differences in the relationship between state-level sexism and barriers to health care access among non-Hispanic White, non-Hispanic Black, and Hispanic women in the United States. Methods. We merged a multidimensional state-level sexism index compiled from administrative data with the national Consumer Survey of Health Care Access (2014–2019; n = 10 898) to test associations between exposure to state-level sexism and barriers to access, availability, and affordability of health care. Results. Greater exposure to state-level sexism was associated with more barriers to health care access among non-Hispanic Black and Hispanic women, but not non-Hispanic White women. Affordability barriers (cost of medical bills, health insurance, prescriptions, and tests) appeared to drive these associations. More frequent need for care exacerbated the relationship between state-level sexism and barriers to care for Hispanic women. Conclusions. The relationship between state-level sexism and women’s barriers to health care access differs by race/ethnicity and frequency of needing care. Public Health Implications. State-level policies may be used strategically to promote health care equity at the intersection of gender and race/ethnicity. (Am J Public Health. Published online ahead of print September 2, 2021: e1–e10. https://doi.org/10.2105/AJPH.2021.306455 )

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