Private Insurers’ Payments For Routine Physician Office Visits Vary Substantially Across The United States
Open Access
- 1 September 2013
- journal article
- Published by Health Affairs (Project Hope) in Health Affairs
- Vol. 32 (9), 1583-1590
- https://doi.org/10.1377/hlthaff.2013.0309
Abstract
Anecdotal reports suggest that substantial variation exists in private insurers’ payments for physician services, but systematic evidence is lacking. Using a retrospective analysis of insurance claims for routine office visits, consultations, and preventive visits from more than forty million physician claims in 2007, we examined variations in private payments to physicians and the extent to which variation is explained by patients’ and physicians’ characteristics and by geographic region. We found much variation in payments for these routine evaluation and management services. Physicians at the high end of the payment distribution were generally paid more than twice what physicians at the low end were paid for the same service. Little variation was explained by patients’ age or sex, physicians’ specialty, place of service, whether the physician was a “network provider,” or type of plan, although about one-third of the variation was associated with the geographic area of the practice. Interventions that promote more price-consciousness on the part of patients could help reduce health care spending, but more data on the specific causes of price variation are needed to determine appropriate policy responses.Keywords
This publication has 8 references indexed in Scilit:
- Health Care as a “Market Good”? Appendicitis as a Case StudyJAMA Internal Medicine, 2012
- The Increased Concentration Of Health Plan Markets Can Benefit Consumers Through Lower Hospital PricesHealth Affairs, 2011
- Unchecked Provider Clout In California Foreshadows Challenges To Health ReformHealth Affairs, 2010
- Estimation and Identification of Merger Effects: An Application to Hospital MergersThe Journal of Law and Economics, 2009
- Managed care's price bargaining with hospitalsJournal of Health Economics, 2009
- The effects of market structure and bargaining position on hospital pricesJournal of Health Economics, 1992
- Price Differences in Almost Competitive MarketsThe Quarterly Journal of Economics, 1979
- The Economics of InformationJournal of Political Economy, 1961