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The effect of generalist-specialist integration on physician behavior, medical outcomes, and medical care spending / Punzalan, Michael.
- Format:
- Book
- Thesis/Dissertation
- Author/Creator:
- Punzalan, Michael, author.
- Language:
- English
- Subjects (All):
- Economics.
- Health care management.
- Health Care Management & Economics--Penn dissertations.
- Penn dissertations--Health Care Management & Economics.
- Local Subjects:
- Economics.
- Health care management.
- Health Care Management & Economics--Penn dissertations.
- Penn dissertations--Health Care Management & Economics.
- Genre:
- Academic theses.
- Physical Description:
- 1 online resource (197 pages)
- Contained In:
- Dissertation Abstracts International 78-04A(E).
- Place of Publication:
- [Philadelphia, Pennsylvania] : University of Pennsylvania ; Ann Arbor : ProQuest Dissertations & Theses, 2016.
- Language Note:
- English
- System Details:
- Mode of access: World Wide Web.
- text file
- Summary:
- I study the effects of integration among generalist and specialist physicians on referral and treatment choices, inpatient admissions, and the cost of medical care. I first construct a novel data set that links the structure of physician organizations to physician behavior for two groups of individuals deemed most likely to benefit from generalist-specialist integra- tion: individuals diagnosed with hypertension and diabetes mellitus. Due to differential selection across integrated and non-integrated practices, ordinary least squares regression is unlikely to identify the effects of interest. To surmount the identification problem, I simulate random assignment of beneficiaries to physician organizations in an instrumental variables framework. My estimates confirm that integration among generalist and special- ists significantly affects referral decisions and treatment patterns. I fail to detect evidence that this kind of integration improves medical outcomes or reduces medical care spend- ing. These findings strongly suggest that policies increasing generalist-specialist integration in piece-rate or fee-for-service environments are unlikely to achieve their goals. Finally, I consider the theoretical literature that might rationalize generalist-specialist integration patterns. I show that most potential explanations are inconsistent with my evidence, save for David and Neuman (2011), suggesting that task adhesion should be a focal point for future research.
- Notes:
- Source: Dissertation Abstracts International, Volume: 78-04(E), Section: A.
- Advisors: Guy David; Robert J. Town; Committee members: Lawton R. Burns; Mark V. Pauly.
- Department: Health Care Management & Economics.
- Ph.D. University of Pennsylvania 2016.
- Local Notes:
- School code: 0175
- ISBN:
- 9781369340372
- Access Restriction:
- Restricted for use by site license.
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