Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?

Clemens, Jeffrey; Gottlieb, Joshua D.

doi:10.1257/aer.104.4.1320

Cited by 383 publications

(292 citation statements)

References 48 publications

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“…The same holds when comparing Mix-CAP-2 and Mix-CAP-4 to CAP (p < 0.001). These results imply that a larger weight on the lump-sum component in These observations complement Clemens and Gottlieb (2014), who report that patients health is affected by a variation in the payment system.…”

Section: Aggregate Provision Behaviorsupporting

confidence: 81%

“…Some empirical studies demonstrate that physicians respond to enhanced fees in an FFS system with an increase in the volume of services (e.g., Yip, 1998;Kantarevic et al, 2011). Clemens and Gottlieb (2014) find that physicians respond to fee changes mostly for elective services. Not so much is known, empirically, about the behavioral responses to varying degrees of supply-side cost sharing.…”

Section: Related Literaturementioning

confidence: 96%

“…Table 1 4 Varying patients' characteristics in our lab experiment is motivated by the recent theoretical literature (see, e.g., Allard et al 2011), which assumes that patient characteristics affect physicians' behavior. The relevance of the patient health benefits is also emphasized by a recent empirical study by Clemens and Gottlieb (2014) who investigate the impact of changes in reimbursement rates on patients' health benefit.…”

Section: Payment Systemsmentioning

confidence: 99%

“…For example, an increase in the reimbursement rate decreases the mortality of younger cardiac patients within 4 years, while older cardiac patients (of age 75 or above) face an increase in mortality within 4 years (see Clemens andGottlieb, 2014, p.1345). 5 Note that this is an essential design feature differing from that of Hennig-Schmidt et al (2011), which does not allow for a systematic analysis of the effects of overprovision and underprovision.…”

Section: Payment Systemsmentioning

confidence: 99%

“…These novel design features differentiate our study from earlier experiments (e.g., Hennig-Schmidt et al, 2011). Further, as the patient population is kept constant across payment systems, we are able to investigate-within the confines of our experiment-the impact of a payment system variation on patients' health benefits, a relevant topic in the recent empirical literature (e.g., Clemens and Gottlieb, 2014 In their seminal model, in which a physician values both her own profit and the patient's health benefit, Ellis and McGuire (1986) show that mixed payment systems induce the optimal level of health care services. We use a variant of their model to derive behavioral predictions for our experiment.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The Effects of Introducing Mixed Payment Systems for Physicians Experimental Evidence

et al. 2015

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Section: Aggregate Provision Behaviorsupporting

confidence: 81%

Section: Related Literaturementioning

confidence: 96%

Section: Payment Systemsmentioning

confidence: 99%

Section: Payment Systemsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Effects of Introducing Mixed Payment Systems for Physicians Experimental Evidence

et al. 2015

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Financial Incentives to Facilities and Clinicians Treating Patients With End-stage Kidney Disease and Use of Home Dialysis

Einav

Mahoney

et al. 2022

JAMA Health Forum

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ImportanceHome dialysis rates for end-stage kidney disease (ESKD) treatment are substantially lower in the US than in other high-income countries, yet there is limited knowledge on how to increase these rates.ObjectiveTo report results from the first year of a nationwide randomized clinical trial that provides financial incentives to ESKD facilities and managing clinicians to increase home dialysis rates.Design, Setting, and ParticipantsResults were analyzed from the first year of the End-Stage Renal Disease Treatment Choice (ETC) model, a multiyear, mandatory-participation randomized clinical trial designed and implemented by the US Center for Medicare &amp; Medicaid Innovation. Data were reported on Medicare patients with ESKD 66 years or older who initiated treatment with dialysis in 2021, with data collection through December 31, 2021; the study included all eligible ESKD facilities and managing clinicians. Eligible hospital referral regions (HRRs) were randomly assigned to the ETC (91 HRRs) or a control group (211 HRRs).InterventionsThe ESKD facilities and managing clinicians received financial incentives for home dialysis use.Main Outcomes and MeasuresThe primary outcome was the percentage of patients with ESKD who received any home dialysis during the first 90 days of treatment. Secondary outcomes included other measures of home dialysis and patient volume and characteristics.ResultsAmong the 302 HRRs eligible for randomization, 18 621 eligible patients initiated dialysis treatment during the study period (mean [SD] age, 74.8 [1.05] years; 7856 women [42.1%]; 10 765 men [57.9%]; 859 Asian [5.2%], 3280 [17.7%] Black, 730 [4.3%] Hispanic, 239 North American Native, and 12 394 managing clinicians. The mean (SD) share of patients with any home dialysis during the first 90 days was 20.6% (7.8%) in the control group and was 0.12 percentage points higher (95% CI, −1.42 to 1.65 percentage points; P = .88) in the ETC group, a statistically nonsignificant difference. None of the secondary outcomes differed significantly between groups.Conclusions and RelevanceThe trial results found that in the first year of the US Center for Medicare &amp; Medicaid Innovation–designed ETC model, HRRs assigned to the model did not have statistically significantly different rates in home dialysis compared with control HRRs. This raises questions about the efficacy of the financial incentives provided, although further evaluation is needed, as the size of these incentives will increase in subsequent years.Trial RegistrationClinicalTrials.gov Identifier: NCT05005572

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Trends in and Factors Contributing to the Slowdown in Medicare Spending Growth, 2007-2018

et al. 2022

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ImportanceAfter decades of rapid increase, Medicare per-beneficiary spending growth was historically low in the period leading up to the passage of the Affordable Care Act. In the years immediately following the legislation, Medicare expenditure growth slowed even further.ObjectiveTo evaluate factors contributing to the slowdown in Medicare per-beneficiary spending growth.Design, Setting, and ParticipantsIn this cross-sectional study, expected spending growth for 2012 to 2015 and 2016 to 2018 was predicted holding payment rates and population characteristics constant. By contrasting predicted and actual spending growth during these periods, the contribution of population vs payment factors to the Medicare spending slowdown was determined. Analyses included all Medicare fee-for-service beneficiaries aged 65 years and older, ranging from 30 to 35 million beneficiaries annually between 2007 and 2018. Data analyses were conducted from January 2018 to August 2018 and updated with new data in June 2021.Main Outcomes and MeasuresThe main outcome included annual growth in total per-beneficiary spending. The roles of payment rate changes and differences in the Medicare population over time were considered, including demographic characteristics and numbers of chronic conditions.ResultsBetween 2008 to 2011 and 2012 to 2015, the adjusted annual Medicare Parts A and B per-beneficiary spending growth rate declined from 3.3% to −0.1%. From 2016 to 2018, the mean annual Medicare spending growth rate rose relative to the previous period but remained lower than in the baseline period at 1.7% per year. This slowdown extended across all sectors within Parts A and B, except for physician-administered drugs offered under Part B. Changes in payment rates (including sequestration measures) and beneficiary characteristics explained 44% of the difference in overall per-beneficiary spending growth between 2007 to 2011 and 2012 to 2015, and 63% between 2007 to 2011 and 2016 to 2018.Conclusions and RelevanceIn this cross-sectional study of trends in spending growth per Medicare beneficiary aged 65 years or older, results suggested that Medicare payment policy, including sector-specific payment rate changes and sequestration, will be a critical determinant of whether the Medicare spending growth slowdown persists.

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Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?

Cited by 383 publications

References 48 publications

The Effects of Introducing Mixed Payment Systems for Physicians Experimental Evidence

The Effects of Introducing Mixed Payment Systems for Physicians Experimental Evidence

Financial Incentives to Facilities and Clinicians Treating Patients With End-stage Kidney Disease and Use of Home Dialysis

Trends in and Factors Contributing to the Slowdown in Medicare Spending Growth, 2007-2018

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