Physician Utilization
Medical CarePublished 1 November 2002
John M. Eisenberg
Citations70
SJR quartileQ1
SJR score1.57
SNIP1.38
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
Abstract
From the Section of General Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. Supported in part by the National Center for Health Sciences Research (Grant 5 R01 HS04953) and the Robert Wood Johnson Foundation. The views expressed are those of the author and do not necessarily represent those of the National Center for Health Services Research nor the Robert Wood Johnson Foundation. Presented, at the HSR 84: Planning for the Third Decade of Health Services Research conference of the National Center for Health Sciences Research, Savannah, Georgia, October 17, 1984. Address correspondence and reprint requests to: William M. Tierney, MD, HSR&D Service (11H), Roudebush VA Medical Center, 1481 West Tenth Street, Indianapolis, IN 46202. E-mail: [email protected] Reprinted with permission from Medical Care 1985;23:461–483. Copyright © 1985 by J.B. Lippincott Company.
Keywords
Economics, Econometrics and FinanceHealth Professions
New England Journal of MedicineImproving Drug-Therapy Decisions through Educational Outreach
862 Citations1983Jerry Avorn, Stephen B. Soumerai
Physicians who were offered personal educational visits by clinical pharmacists along with a series of mailed "unadvertisements" reduced their prescribing of the target drugs by 14 per cent as compared with controls, resulting in substantial cost savings.
Health AffairsDealing With Medical Practice Variations: A Proposal for Action
719 Citations1984John E. Wennberg
During his research pursuits, John Wennberg has uncovered systematic and persistent differences in the standardized rates of use for common surgical procedures and other medical services in the United States.
New England Journal of MedicineDoes Free Care Improve Adults' Health?
668 Citations1983Robert H. Brook, John E. Ware +8 more
Annals of Internal MedicineReminders to Physicians from an Introspective Computer Medical Record
641 Citations1984Clement J. McDonald, Siu L. Hui +5 more
A computer-stored medical record system containing a limited set of the total clinical data base--primarily diagnostic studies and treatments responds to its own content according to physician-authored reminder rules according to 1490 rules on physician behavior.
Social Science & MedicineProfessional uncertainty and the problem of supplier-induced demand
597 Citations1982John E. Wennberg, Benjamin A. Barnes +1 more
The evidence reviewed here supports the hypothesis that variations occur to a large extent because of differences among physicians in their evaluation of patients or in their belief in the value of the procedures for meeting patient needs.
New England Journal of MedicineSome Interim Results from a Controlled Trial of Cost Sharing in Health Insurance
562 Citations1981Joseph P. Newhouse, Willard G. Manning +9 more
Interim results indicate that persons fully covered for medical services spend about 50 per cent more than do similar persons with income-related catastrophe insurance, which leads to more people using services and to more services per user.
Annals of Internal MedicineSociologic Influences on Decision-Making by Clinicians
427 Citations1979John M. Eisenberg
Observations from the literature of sociology, clinical psychology, psychiatry, and medicine are presented to illustrate sociologic influences on clinical decision-making.
New England Journal of MedicineHow Do Health-Maintenance Organizations Achieve Their “Savings”?
301 Citations1978Harold S. Luft
New England Journal of MedicineA Trial of Two Strategies to Modify the Test-Ordering Behavior of Medical Residents
293 Citations1980Albert R. Martin, Marshall A. Wolf +3 more
Two methods to reduce the ordering of laboratory and radiologic tests by medical residents in their first postgraduate year by dividing the residents into three groups are studied.
The Journal of Human ResourcesThe Supply of Surgeons and the Demand for Operations
275 Citations1978Victor R. Fuchs
The results provide considerable support for the hypothesis that surgeons shift the demand for operations, and seem to have a perverse effect on fees, raising them when the surgeon/population ratio increases.
New England Journal of MedicineWill Payment Based on Diagnosis-Related Groups Control Hospital Costs?
274 Citations1984John E. Wennbero, Klim McPherson +1 more
It is concluded that, to be successful, cost-containment programs based on fixed, per-admission hospital prices will need to ensure effective control of hospitalization rates.
Medical CareImproving Physician Compliance With Preventive Medicine Guidelines
268 Citations1982David I. Cohen, Benjamin Littenberg +2 more
It is concluded that this intervention was clearly effective in the short run, however, follow-up studies will be necessary to determine whether the desired long-term effect has been achieved.
Medical CareThe Impact of Changing Medicare Reimbursement Rates on Physician-Induced Demand
261 Citations1983Thomas Rice
Examination of changes in Medicare reimbursement rates affects the degree to which physicians induce demand for Medicare services shows that demand inducement appears to take several forms: provision of more highly intensive medical and surgical services, greater quantities of surgical Services, and ordering of more laboratory tests.
The Journal of Human ResourcesPhysician Participation in State Medicaid Programs
245 Citations1978Frank A. Sloan, Janet B. Mitchell +1 more
Results indicate that high fee schedules and low administrative burdens are ways to stimulate physician involvement with Medicaid patients, and lend support to the model of physician behavior proposed.
JAMAImproving antibiotic prescribing in office practice. A controlled trial of three educational methods
233 Citations1983William Schaffner
PEDIATRICSChanges in Tonsillectomy Rates Associated With Feedback and Review
167 Citations1977John E. Wennberg, Lewis Blowers +2 more
The experience suggests that feedback of population-based data on incidence of procedures may be a valuable tool for the peer review process.
Medical CareHow Good Are the Data?
165 Citations1982Leslíe L. Roos, Noralou P. Roos +2 more
Face sheet information and data on the performance of major surgical procedures were found to be reliably recorded in the Manitoba data bank, and collapsing ICD-8 diagnoses from medical claims into several categories proved much better than relying upon individual diagnoses.
Medical CareImproving Physician Performance Through Peer Comparison Feedback
165 Citations1984Richard N. Winickoff, Kathy L. Coltin +3 more
A project to improve physician performance in colorectal cancer screening was evaluated as part of an ambulatory quality assurance program, and behavior changes persisted at 6 and 12 months after intervention.
JAMAThe failure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital
155 Citations1984Sissel Schroeder
American Journal of Public HealthHysterectomy: variations in rates across small areas and across physicians' practices.
147 Citations1984Noralou P. Roos
A combination of patient and physician characteristics may explain much of the variation in small area hysterectomy rates, rather than narrowly defined medical need.
The Milbank Memorial Fund Quarterly Health and SocietyThe Relative Importance of Physician-Induced Demand in the Demand for Medical Care
134 Citations1983Gail R. Wilensky, Louis F. Rossiter
Expectations about the market for physicians in the 1980s are not described because of the lack of appropriate consumer information entailing reliance on providers as suppliers of information which is thought to produce an interdependence between supply and demand.
Medical CareThe Relationship between Physician Characteristics and Prescribing Appropriateness
130 Citations1972Paul D. Stolley, Marshall H. Becker +3 more
This investigation found more appropriate prescribers to be younger, more recent graduates who have taken additional courses and postgraduate training, but who have had fewer years of experience in practice, maintain larger, hurried practices with more ancillary assistants, and spend less time with each patient.
Arthritis & RheumatismEvaluation of a continuing education program in rheumatoid arthritis
116 Citations1980Jeoffrey K. Stross, Giles G. Bole
Although inpatient and outpatient audits of physician records demonstrated little change in three control communities, substantial improvement in the utilization of diagnostic procedures and patient management was documented in the three intervention communities utilizing the influential physicians.
Medical CareSurgical Rate Variations: Do They Reflect the Health or Socioeconomic Characteristics of the Population?
114 Citations1982Noralou P. Roos, Leslíe L. Roos
Variations in surgical rates among the elderly across 56 small rural areas are compared with variations in characteristics of the elderly population of these areas including self-reported health status, levels of disability, mental status, socioeconomic status, ethnic characteristics, etc.
Medical CareDoes Cost Information Availability Reduce Physician Test Usage?
111 Citations1982David I. Cohen, Paul K. Jones +2 more
Four similar teams of physicians associated with similar inpatient units and randomly assigned patients were used to study the effect of providing physicians with cost information about their use of lab tests and x-rays.
Annals of Internal MedicineUse of Laboratory Tests in a Teaching Hospital: Long-Term Trends
108 Citations1979Paul F. Griner
Factors responsible for the observed stability in numbers of laboratory tests per patient per hospitalization included, but were not limited to, increased reliance on test batteries as opposed to individual tests; changing patterns of care leading to decreased use of nonautomated tests; and the impact of administrative and educational strategies directed toward optimum use of the laboratory.
Medical CareA Review of Physician Cost-Containment Strategies for Laboratory Testing
101 Citations1983Randolph M. Grossman
The role of the physician as a contributor to the health care cost problem and the state of physician cost-control strategies relative to laboratory testing in confronting this national problem are reviewed.
American Journal of Public HealthThe effect of immediate access to a computerized medical record on physician test ordering: a controlled clinical trial in the emergency room.
96 Citations1982Gregory Wilson, Clement J. McDonald +1 more
A randomized clinical trial of the effect of immediately printed summaries of a computerized medical record on physician test ordering rates in an Emergency Room setting found no significant effect on either medical or surgical test ordering during time period T2.
Medical CareUse of Diagnostic Services by Physicians in Community Practice
94 Citations1981John M. Eisenberg, David Nicklin
The number of years since medical school graduation showed a statistically significant inverse relationship with laboratory and radiology use, and public school graduates ordered more laboratory tests than private school graduates, and foreign medical graduatesordered more roentgenograms than domestic graduates.
American Journal of Public HealthHospitalization of medicaid children: analysis of small area variations in admission rates.
87 Citations1981F A Connell, randy Day +1 more
Primary analysis indicates that differences in admission rates were not associated with: medical need or demographic factors, epidemic patterns of disease, physician supply, hospital bed supply or occupancy rates, or severity of disease or delay in seeking medical care as reflected by average length of stay.
New England Journal of MedicineDecentralized Management in a Teaching Hospital
79 Citations1984Robert M. Heyssel, J. Richard Gaintner +3 more
For more than a decade American hospitals have been asked to contain costs, and the most recent program is the Medicare prospective payment system, which reimburses hospitals a fixed price per case per year.
Medical CareThe Effects of Price Information on Physicians?? Test-Ordering Behavior
76 Citations1982K. Michael Cummings, Kenneth B. Frisof +2 more
The study results show that for each of the four cases, the average number of diagnostic tests ordered was significantly lower in the price-information group than in the control group, and an average reduction in the cumulative cost of tests ordered per patient is shown.
New England Journal of MedicineDoes the Primary-Care Gatekeeper Control the Costs of Health Care?
66 Citations1983Stephen H. Moore, Diane P. Martin +1 more
In June 1979, an article in the Journal 1 described a new type of independent practice association (IPA), which was designed to encourage primary-care physicians in private practice to becomecoordinators of an IPA.
Evaluation & the Health ProfessionsDetermining Physicians' Performance
56 Citations1983Paul J. Sanazaro
Analysis of the literature reveals that CME in all its forms is effective in improving competence, however, that competence is not regularly reflected in physicians'itual performance in the care of patients.
Medical CareThe Effect of Medical Training Factors on Physician Utilization Behavior
56 Citations1977Raynald Pineault
The data reported here show that physicians trained in medical schools and hospitals with a scientific medical orientation generally use fewer clinical and technical resources than other physicians, however, under conditions of uncertainty, that is, when diagnosis is unknown, they tend to use more services.
American Journal of Public HealthControlling the rise in cesarean section rates by the dissemination of information from vital records.
56 Citations1983Ronald L. Williams, P M Chen
An indirect standardization technique is applied to three years of California vital records data to show sizable variations in cesarean section rates among individual hospitals and by hospital type, both before and after standardization.
Medical CareThe Development of Dental Practice Profiles
51 Citations1981Howard L. Bailit, Jonathan Clive
Of the patient and insurance characteristics investigated, only patient age had a major effect on utilization rates, and there was considerable stability in utilization rates within practices over four consecutive six-month time intervals.
JAMACost containment and changing physicians' practice behavior. Can the fox learn to guard the chicken coop?
47 Citations1981John M. Eisenberg
Medical CareThe Efficacy of Second-Opinion Consultation Programs: A Cost???Benefit Perspective
47 Citations1982Hirsch S. Ruchlin, Madelon Lubin Finkel +1 more
Findings indicate that mandatory second-opinion consultation programs, which are consumer oriented and intervene before care is rendered, are clearly cost-effective.
Preventive MedicineChanges in physician behavior and cost savings associated with organizational recommendations on the use of “routine” chest X rays and multichannel blood tests
46 Citations1983Robert S. Thompson, Howard L. Kirz +1 more
A decision-making process and educational campaign technology hold promise for GHC's preventive medicine program in the future and a cost savings of $166,582 (annually) resulted from this diminution in "nonindicated" testing.
New England Journal of MedicinePeer Review: Impact of a System Based on Billing Claims
41 Citations1974Charles R. Buck, Kerr L. White
To determine whether adjustment of billing claims made by a peer-review mechanism affects subsequent practice patterns, the records of the San Joaquin Foundation for Medical Care were examined.
Medical CareDifferences in Medical Referral Decisions for Obesity Among Family Practitioners, General Internists, and Gynecologists
40 Citations1984Marilyn L. Rothert, David R. Rovner +4 more
Variation in the decisions of primary care physicians to refer or not to refer obese patients to an endocrinologist and the principles underlying their decisions are explored.
Medical CareThe Interaction Among the Criteria Physicians Use When Prescribing
38 Citations1982Robert N. Zelnio
It was discovered that physicians could be segregated into two distinct segments based on the importance of the prescribing criteria, and it was not possible, however, to explain the composition of the groups using the physician and practice characteristics measured.
American Journal of Public HealthSupply, workload and utilization: a population-based analysis of surgery in rural Manitoba.
33 Citations1983Leslíe L. Roos
Several models of physician behavior were investigated using data on individual procedures as well as overall figures, and a model emphasizing the importance of physician discretion appeared to provide the best fit with the data.
Medical CareClinical Styles and Motivation: A Study of Laboratory Test Use
32 Citations1975David F. Hardwick, Patricia Vertinsky +4 more
The study reported in this paper examines clinical reasoning styles with a focus on laboratory utilization to indicate the variety inherent in physician decision-making strategies and point to the necessity of employing a cautious and flexible approach toward any general scheme of constraints upon medical diagnostic procedures.
New England Journal of MedicinePhysician Responsibility for the Cost of Unnecessary Medical Services
29 Citations1978John M. Eisenberg, Arnold J. Rosoff
A peer-review system that would incorporate the sharing of financial risk among physician, hospital, insurer and patient in the fee-for-service sector is proposed.
Medical CarePhysician Sensitivity to the Price of Diagnostic Tests
27 Citations1982John Hoey, John M. Eisenberg +2 more
Education of physicians regarding the price of diagnostic tests may alter their use of these services, but a large proportion of tests are ordered because of clinically absolute reasons, which may be insensitive to price.
Medical CareImpact of a Cost-Containment Educational Program on Housestaff Ambulatory Clinic Charges
27 Citations1983William B. Applegate, Max D. Bennett +3 more
A broad educational program that coupled clinical logic with feedback of charges to internal medicine residents in an ambulatory clinic setting could alter behavior resulted in a decrease in mean laboratory changes and total charges for ambulatory encounters.
American Journal of Public HealthAn empiric study of ecological inference.
26 Citations1984Martin J. Connor, D Gillings
Using as a database hospital episodes of care for the North Carolina Medicare aged population, regression models are developed from an examination of geographic grouping effects to explore the impact of extended care services, skilled nursing facility, and home health agency care on acute care hospital days.
Social Science & MedicineWhy do physicians in neonatal care units differ in their admission thresholds?
18 Citations1984Dave Campbell
Correlational analysis indicated that organisational factors like size of hospital, teaching status and availability of cots were particularly strongly related to admission rates, but that the physician's characteristics and attitudes also played some influence on the physicians' behaviour.
Medical CareThe Use of Ancillary Services: A Role for Utilization Review?
17 Citations1982John M. Eisenberg
Several principles for ancillary services review may be set forth, including problem identification, design of the audit system, determination of requirements for data and development of data sources.
American Journal of Public HealthThe effect of a thirty per cent reduction in physician fees on Medicaid surgery rates in Massachusetts.
16 Citations1981Michael Shwartz, Sue-Ann Martin +4 more
Tonsillectomy/adenoidectomy is the only procedure in which there was a statistically significant decline in the rate of surgery in most areas of the state following the fee cut, and there is some evidence of an increase in the rates of disc surgeries/spinal fusions.
Medical CareEvaluation of a Focused Dental Utilization Review System
13 Citations1983Howard L. Bailit, Jay Balzer +1 more
The study suggests that further development of focused review systems requires a better understanding of the association between utilization rates and overutilization and new methods for improving the reliability of reviewers.
Journal of Health EconomicsA model of physicians' practice attributes determination
13 Citations1983Anthony E. Boardman, Bryan Dowd +2 more
The paper provides new insights into physician decision-making and, in particular, the positive relationship between fees and the number of physicians.
American Journal of Public HealthMonitoring ambulatory care: impact of a surveillance program on clinical practice patterns in New York City.
12 Citations1980M Paris, John R. McNamara +1 more
Billing patterns of the physicians subject to program sanctions, as well as the larger universe of all participating New York City physicians, showed changes coincident with the introduction of the surveillance program: utilization of x-rays, lab tests, injections, and first visit billing decreased.
Medical CareAdministrative Change and Diagnostic Test Use
12 Citations1984Elliot J. Sussman, Peter Goodwin +1 more
The effects of an administrative change that limited physicians' ability to order routine diagnostic tests were studied, which may lead to false-positive tests and thus to even more unnecessary follow-up testing.
Evaluation & the Health ProfessionsTeaching Technologic Restraint
9 Citations1978Rodney B. Nelson
It was found that physicians could be taught restraint but that constant reinforcement and emphasis would be necessary to make voluntary technologic restraint useful and that economic rationing might become necessary to control costs.
Medical CareSecond-Opinion Programs
9 Citations1982Robert H. Brook, Kathleen N Lohr
In this issue of Medical Care appear two new, carefully done studies of how to control the amount of "unnecessary" surgery performed in the United States.
Archives of Internal MedicineThe clinical value of the upper gastrointestinal tract roentgenogram series
8 Citations1980K. I. Marton
Clinical ChemistryLimited usefulness of the proportion of tests with normal results in review of diagnostic services utilization.
7 Citations1983John M. Eisenberg, Suzanne Williams
There was a significant correlation between the proportion of normal results in tests ordered by residents and the residents' audit-disapproval rates, a previously undocumented relationship, but it is not strong enough to use the proportionOf normal results as a measure of a physician's inappropriate test use, except to select physicians for utilization review.
New England Journal of MedicineEconomic versus Professional Incentives for Cost Control
6 Citations1982Gerald T. Perkoff
In this issue of the Journal Wennberg makes a new proposal based on his and his co-workers' demonstration that physicians' decisions overshadow all the other major factors that are thought to affect the use and thereby the cost of medical care.
JAMAMedical practice, case mix, and cost containment. A new role for the attending physician
5 Citations1982D. W. Young