Biomedical subjects

A A Scitovsky

Publications and source records attributed to A A Scitovsky.

4 recordsLinked to original sources

PubMed1979

Use of physician services under two prepaid plans.

Use of physician services under two prepaid plans offered to Stanford University staff is analyzed and compared. One is a Kaiser plan; under the other (Clinic plan), physician and outpatient ancillary services are provided by a predominantly fee-for-service group practice and hospital services are covered by a Blue Cross policy. The two plans provide much the same benefits but, in addition to the difference in their organization, they differ in their financial provisions. While the Kaiser plan has only a token copayment for office and home visits, the Clinic plan has a 25 per cent coinsurance provision applying to all physician and outpatient ancillary services. Despite these differences, the mean number of physician visits per year is the same for the two groups after account is taken of differences in age composition, socioeconomic status, health status, attitudes toward seeking care, length of plan membership, family size and satisfaction with the plan. However, when adjustment is also made for differences in physician affiliation, the Kaiser rate becomes half a visit higher than the Clinic rate. This is because under both plans, members who have a specific plan physician as regular source of care use more services than those without one, and because only 42 per cent of Kaiser members compared with 87 per cent of Clinic members stated that they had a specific plan physician.

Age Factors↗

PubMed1978

Factor affecting the choice between two prepaid plans.

This study examines the factors affecting the choice between two comprehensive prepaid plans of medical care available to the staff of Stanford University. One is a Kaiser plan, offered since 1969. Under the other (Clinic plan for short), medical services are provided by a predominantly fee-for-service group practice and hospital services are covered by a standard Blue Cross hospital policy; the Clinic plan has been available since the 1950s. The Kaiser plan has only a token copayment for office and home visit while the Clinic plan has a 25 per cent coinsurance provision applying to all physician and outpatient ancillary services. It was found that the two major factors affecting choice were income and distance to the provider. The preference for the Kaiser plan increased as income decreased. Similarly, as distance from the Clinic increased and distance from a Kaiser facility decreased, the preference for the Kaiser plan increased. However, proximity to the provider was a more important factor for the higher-income Clinic plan subscribers. The data also show that the longer availability of the Clinic plan had a long-term effect on enrollment. A substantial proportion of long time Stanford employees who might have been expected to prefer the Kaiser plan stayed with the Clinic plan.

Attitude to Health↗

PubMed1977

Coinsurance and the demand for physician services: four years later.

In 1971 a study was made of the effects of a 25-percent coinsurance provision on the demand for physician services under a comprehensive prepaid plan for medical care. Comparing physician utilization rates in 1966 (the year before coinsurance was introduced) and 1968 (the first calendar year after the change) showed that coinsurance led to a 24-percent decline in the per capita number of all physician visits that held true regardless of how the data were examined--whether by demographic characteristics of the study population, physician specialization, or place of visit. This effect of coinsurance could be temporary--a kind of shock effect that would wear off. Since there was no conclusive proof of this hypothesis, the authors conducted a followup study, comparing physician utilization rates in 1972 and 1968. They found no evidence of any upward trend in the use of physician services. The overall utilization rate was much the same in 1972 as in 1968, and the rates of the demographic subgroups and types of visits were either much the same or slightly lower. Equally important was the finding that the plan had become relatively unattractive for families in the lowest socioeconomic group who constituted a smaller proportion of the 1972 plan membership than of the pre-coinsurance membership.

Adolescent↗

PubMed1976

A method of estimating physician requirements.

This article describes and applies a method of estimating physician requirements for the United States based on physician utilization rates of members of two comprehensive prepaid plans of medical care providing first-dollar coverage for practically all physician services. The plan members' physician utilization rates by age and sex and by field of specialty of the physician were extrapolated to the entire population of the United States. On the basis of data for 1966, it was found that 34 percent more physicians than were available would have been required to give the entire population the amount and type of care received by the plan members. The "shortage" of primary care physicians (general practice, internal medicine, and pediatrics combined) was found to be considerably greater than of physicians in the surgical specialties taken together (41 percent as compared to 21 percent). The paper discusses in detail the various assumptions underlying this method and stresses the need for careful evaluation of all methods of estimating physician requirements.

Adolescent↗