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Biomedical subjects

J A Rizzo

Publications and source records attributed to J A Rizzo.

8 recordsLinked to original sources
PubMed1992

Supply and demand factors in the determination of Medicare expenditures.

This article presents multivariate estimates of the effects of supply-side factors (e.g., provider reimbursement) and demand-side factors (e.g., beneficiary ability to pay) on state-level expenditures per enrollee in Medicare Part A and Part B. The results indicate that a 1 percent increase in elderly income significantly increases the propensity to use Medicare Part B services, resulting in a 0.45 percent increase in Part B expenditures per enrollee. By contrast, patients' ability to pay has a much weaker effect on Part A expenditures. Changes in provider reimbursement also exert a substantial effect on expenditures. A 1 percent rise in the Medicare Prevailing Charge Index raises Medicare Part B expenditures by 0.43 percent. Collectively, the findings of this study suggest that both limits on Medicare reimbursement to providers and increased beneficiary liability have substantial effects on Medicare costs. Whatever the merits of arguments for or against such controls, the responsiveness of Medicare expenditures to equal percentage changes in supply and demand factors appears to be of a similar order of magnitude.

Aged↗
PubMed1991

Physician referrals and the medical market place.

Factors determining the extent to which physicians obtain new patients through referrals are examined. A more thorough understanding of physician referral patterns can help to explain how competitive forces function in this market and how physician characteristics and credentials affect individual performance. Referral networks promote entry by young physicians into both primary and nonprimary care medical markets. Nevertheless, there are marked differences in referral patterns between primary care and nonprimary care providers. For instance, referrals are directly related to the degree of market competition and board-certification status among primary care physicians but not among nonprimary care specialists. Membership in a group practice is related to significantly more referral activity among nonprimary care physicians but not among primary care providers. No significant differences were found in referral patterns by physician sex. Although foreign medical graduates (FMGs) receive proportionately fewer referrals than do U.S. medical graduates, the differences are not large. While earlier research suggests that the returns to board certification are higher for female physicians, the present study finds little evidence that board certification is particularly helpful to either female physicians or to FMGs in terms of obtaining patients on referral.

Certification↗
PubMed1991

Who cares for uninsured persons? A study of physicians and their patients who lack health insurance.

Physician involvement with uninsured patients is a topic of increasing policy interest. In the past, data limitations have hindered analysis of factors influencing physician contact with uninsured patients. This article attempts to bridge this gap in the health services research literature. Using a nationally representative sample of nonfederal patient care physicians, the study revealed marked variations in physician involvement with uninsured patients by specialty class, employment status, and other practice characteristics. Pediatricians and general practitioners had roughly comparable involvement with uninsured patients, while internists and surgeons were significantly less involved. Self-employed physicians generally participated less in caring for uninsured patients than did employed physicians. While definitive evidence that people without coverage face serious access problems is not provided, such a conclusion is certainly consistent with the results of this study. Indeed, the proportion of the average physician's patients who are uninsured is substantially below current estimates of the proportion of the general population that is uninsured.

Data Collection↗
PubMed1990

Physician contact with and attitudes toward HIV-seropositive patients. Results from a national survey.

The growing population of HIV-seropositives raises serious concerns about who will provide medical care to this group. This article presents the first national estimates of physician involvement in, and attitudes toward, the treatment of HIV-seropositive patients. Nearly 50% of the nonfederal patient care physicians in our nationally representative sample have treated at least one HIV patient, with an average of 6.7 such patients being treated per physician. Perceived responsibility to treat HIV-seropositive patients is uniformly strong across such physician and practice characteristics as specialty, years of experience, and practice type. However, there are pronounced differences in actual physician involvement along these dimensions.

Age Factors↗
PubMed1988

Physician advertising revisited.

This article examines the determinants of physician advertising using a nationally representative sample of 2,573 self-employed physicians. In contrast to a previous study by Folland, this article identifies a number of physician characteristics that are strongly related to the advertising decision. In particular, female physicians and foreign medical graduates (FMGs) are significantly less likely to advertise than are males and non-FMGs, respectively. Board certified physicians are less likely to advertise than are uncertified physicians. Also in contrast to previous results, primary care physicians are not necessarily more likely to advertise than nonprimary care physicians. For example, advertising propensity is strongest among plastic surgeons, whereas the propensity to advertise in such primary care specialties as internal medicine and pediatrics are quite close to advertising propensities for general surgeons. Furthermore, the relationship between practice size and advertising propensity is shown to be much stronger than previous research in this area has indicated. Finally, the results suggest that a number of physician characteristics associated with advertising through written media (newspapers or magazines) are also associated with advertising through audiovisual media (television or radio).

Advertising↗
PubMedDate not supplied

[Beclomethasone dipropionate, in high dose, in the treatment of patients with chronic persistent asthma].

The efficacy of inhaled beclomethasone dipropionate (BDP) was examined in 8 patients with chronic persistent asthma, uncontrolled by inhaled bronchodilators and oral theophylline. Beclomethasone was administered at a dose of 1500 mcg a day, using a metered dose inhaler containing 250 mcg of BDP per dose. The medication was administered twice daily, three 250 mcg puffs at 8 A.M. and three at 8 P.M. The patients were assessed by means of clinical examination, diary records and daily Peak Flow Rate (PFR) measurement made at home. The therapeutic responses were measured over an 8-wk period. The clinical score (0-4) improved significantly (3.25 +/- 0.71 before and 0.75 +/- 0.89 after [p < 0.001]), and the peak flow rate rose from baseline mean value of 48.0% +/- 11.9 (predicted value) to 78.8% +/- 16.7% with significant improvement (p < 0.01). Of the total of 8 patients, 5 achieved complete control of symptoms and normal values of PFR, 1 remained with sporadic wheezing but with significant improvement of PFR and 2, despite the clinical efficacy in symptom relief, persisted without significant improvement on PFR values. Transitory hoarseness occurred in 1 patient. No other side-effects were observed.

Adolescent↗
PubMedDate not supplied

The cost of medical professional liability.

The high cost of medical professional liability is a source of growing concern among policymakers, health care consumers, and the medical profession. While the concern is widespread, to date there has been little quantitative evidence on the overall economic impact of the problem. Utilizing data from the American Medical Association's Socioeconomic Monitoring System, the impact of medical professional liability (PL) on the cost of physicians' services has been estimated employing two different methods. Both estimates indicate that the costs of PL are substantial. In particular, the two methods yield estimates of the total cost of PL in 1984 of $13.7 and $12.1 billion, respectively--or approximately 15% of the total expenditures on physicians' services. Furthermore, increased costs associated with PL from 1983 to 1984 alone are estimated under the two methods to have accounted for 63% and 57%, respectively, of the increase in expenditures on physicians' services. These costs include PL insurance premiums, costs of practice changes made in response to increasing PL risk, and costs of incurring claims that are not covered by PL insurance.

American Medical Association↗