Influence of Physician Competition on Health Care Utilization
This study examines the response of physicians, particularly specialists, to growing competition brought on by rapid increases in their numbers and reductions in demand for their services created by the expansion of managed care. The study will use the unique market-oriented structure of the Community Tracking Household Survey as the basis of two urban and rural components. First, for urban sampled sites we will attach descriptive measures of market-wide physician supply and HMO enrollment to each individual record and estimate multivariate models of the degree to which utilization increases with the level of evident physician oversupply. We will then apply the results of the analysis to the National Medical Expenditure Survey in order to estimate the total impact on costs of differential utilization patterns associated with apparent excess physician supply. The second component of the study will examine rural markets, which are characterized by limiting HMO enrollment but sharp differences in physician supplies. We will first use an existing data set on rural communities to profile the nine nonmetropolitan sample sites in terms of local physician supply and average travel distance to specialty physicians. The analysis will then examine the degree to which physician supply characteristics are correlated with variations in utilization.
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