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Title
Physician losses from Medicare and Medicaid discounts: how real are they?
First Author
Cromwell, Jerry L
Date of Pub
1985 Summer
Pages
51-68
Volume
6
Issue
4
Other Authors
Burstein, Philip
Abstract
Physicians' claims that extensive Medicare and Medicaid fee discounting imposes an inequitable burden on them are examined using survey data from the Health Care Financing Administration on 5,000 primary care physicians. A definite fee hierarchy is documented, with the physician's usual charge at the top and Medicare and Medicaid allowables at the bottom. Under usual, customary, and reasonable methods, physicians can use fees to maximize payment, and insurer attempts to control fees result in both sides participating in a revenue maximization-expenditure control game. Raising Medicare and Medicaid allowables to the physician's usual fee is shown to result in large windfall gains that are unnecessary and unjustified in terms of work effort, human capital investment, or eliciting an adequate supply of practitioners.
Abstract Continued
N/A
MeSH
Fee Schedules : Fees, Medical : Rate Setting and Review : Blue Shield : Comparative Study : Income : Medicaid/economics : Medicare/economics : Models, Theoretical : Specialties, Medical/economics : Support, U.S. Gov't, Non-P.H.S. : United States
NTIS Number
PB86-139409