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Biomedical subjects

G C Pope

Publications and source records attributed to G C Pope.

30 records · Page 2Linked to original sources
PubMed1990

A geographic index of physician practice costs.

This paper develops a geographic index of physician practice costs. A Laspeyres index is derived for each Metropolitan Statistical Area and for the non-metropolitan portion of each state. Relative prices by area are obtained for four practice inputs: physicians' own time, employee wages, office rents, and malpractice insurance. Each input price proxy is weighted by the share of physician gross revenues spent on that input. The index is useful in explaining geographic variation in physician fees. It may be used in reforming the way Medicare pays physicians.

Abstracting and Indexing↗
PubMed1990

Using hospital-specific costs to improve the fairness of prospective reimbursement.

Payment rates in Medicare's Prospective Payment System (PPS) are based on averages of historical hospital costs. Compared to reimbursing each hospital's own costs, pricing at the average of costs implies a massive redistribution of payments among hospitals. Because not all sources of hospital costs are accounted for in the PPS, some of this redistribution is 'unfair'. Information in hospital-specific costs on unmeasured patient severity and input prices can be exploited to reduce payment inequities. However, fully hospital-specific rates are not optimal because costs also reflect treatment intensity and efficiency differences among hospitals.

Cost Allocation↗
PubMed1990

Physician inputs, outputs, and productivity, 1976-1986.

This paper presents trends in the aggregate practice inputs, patient care outputs, and productivity of physicians over the past decade. The rising number of physicians has not increased access (total patient contacts) for the population. Instead, it has supported more physician time and medical services per visit. Larger physician requirements attributed to declining productivity are actually the result of greater intensity of care. Physician productivity in supplying medical services has not improved over the past decade, possibly contributing to rapid fee inflation. Observed trends are not consistent with Medicare fee updates that assume productivity gains.

Economics, Medical↗
PubMed1989

Hospital nonprice competition and Medicare reimbursement policy.

This paper analyzes the role of interhospital nonprice competition in Medicare's Prospective Payment System. Competition can play an important role both by increasing quality and reducing managerial slack. The quality-enhancing aspect of competition can be amplified through reimbursement of a proportion of incurred cost. As competition intensifies, the optimal degree of cost sharing (subsidy) falls.

Costs and Cost Analysis↗
PubMed1989

Trends in hospital labor and total factor productivity, 1981-86.

The per-case payment rates of Medicare's prospective payment system are annually updated. As one element of the update factor, Congress required consideration of changes in hospital productivity. In this article, calculations of annual changes in labor and total factor productivity during 1981-86 of hospitals eligible for prospective payment are presented using several output and input variants. Generally, productivity has declined since 1980, although the rates of decline have slowed since prospective payment implementation. According to the series of analyses most relevant for policy, significant hospital productivity gains occurred during 1983-86. This may justify a lower update factor.

Costs and Cost Analysis↗
PubMed1989

Occupational adjustment of the prospective payment system wage index.

In this article, the bias in the Medicare prospective payment system (PPS) hospital wage index that results from its failure to hold hospital occupation mix constant is examined. On average, the difference between the current PPS wage index and a fixed-occupation-mix Laspeyres index is small, approximately 2 percent. However, occupation-mix distortions are substantially larger for a small proportion of labor market areas, especially some in the South. Biases in the wage index resulting from its failure to appropriately account for labor substitution and intra-occupational worker characteristics are also analyzed but are not found to be significant.

Abstracting and Indexing↗
PubMed1989

Physician productivity: trends and determinants.

Projections of a physician surplus for the 1990s have assumed that physician productivity will be constant at 1970s levels. Using the HCFA-NORC physician surveys of 1975, 1979, and 1984-85, this study examines trends in physician productivity over the past decade and estimates the impacts of physician and practice characteristics on current productivity. Visit productivity declined significantly between 1975 and 1984, suggesting that the projected surplus may be overstated. Cross-sectional results show that participation in alternative health plans is not associated with greater productivity, except for the higher work effort of independent practice association participants. The effects of physician time, nonphysician aides, and physician gender on productivity vary with alternative visit and revenues measures of productivity.

Cross-Sectional Studies↗
PubMed1988

Medical conditions, health status, and health services utilization.

Using data from the 1980 National Medical Care Utilization and Expenditure Survey (N = 11,530), four commonly used health status indicators are interpreted in terms of the underlying medical conditions they reflect. It is found that self-rated health status, role limitations, restricted activity days, and functional limitations measure similar conditions. These conditions tend to be chronic and severe; heart and cerebrovascular disease are especially associated with poor health as measured by all of the variables. Disability days is most likely to reflect acute, transitory morbidity. Practical suggestions for the appropriate use of the four variables are made. In addition, the conditions associated with the most ambulatory utilization of health services are identified. Among these conditions, those which are and are not measured adequately by the health status indicators are disclosed. It is concluded that the health status variables, either individually or as a group, do not measure many variations in health that are strongly related to utilization.

Activities of Daily Living↗