Browsing by Subject "Physicians"

Now showing 1 - 5 of 5
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    Essays in Industrial Organization and Health Economics
    (2019-07) Falcettoni, Elena
    This dissertation studies how physicians respond to incentives in terms of: their treatment choice, their geographical distribution in the United States, and their effect on health outcomes. To address this, I exploit micro-data from Medicare at a physician-procedure level. I then supplement this dataset with novel, granular data collected from physicians’ directories that follow physicians from their choice of medical school onward. Chapter 1 introduces the topic and presents an overview of the questions analyzed and results obtained throughout the dissertation. Chapter 2 analyzes primary care physicians’ response to fee-for-service pricing along the urban/rural divide. In particular, it first documents that primary care physicians provide more (remunerative) specialty procedures in less urban areas, where specialists are fewer; secondly, it analyzes how primary care physicians switch to the more remunerative procedures when their fees are increased. Chapter 3 develops a model of physicians’ location choices and uses it to explore the impact of policy changes (loan forgiveness and salary incentives) on the geographical distribution of physicians. Chapter 4 provides evidence on the impact of the physician workforce on health outcomes by exploiting the policy-set fees and the micro-data availability.
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    The experience of burnout among primary care physicians
    (2012-12) Gregory, Sean Thomas
    This dissertation addressed three specific aims, (1) the impact of an organizational change on the experience of burnout for primary care physicians, (2) the fit of a model for burnout in the primary care setting, and (3) modeling the trajectory of the three dimensions of burnout. The research was conducted with primary care physicians employed by a large integrated delivery system in the upper midwest United States, by observing a natural experiment occurring in the owned primary care practices.
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    Neurologists' discussion intentions regarding a medical innovation: an examination of psychological determinants and personal normative influences.
    (2010-10) Langteau, Rita Ann
    Progression of Parkinson's disease (PD) and use of the mainstay drugs to treat the disease leads to severe movement disorders with accompanying disability in a portion of PD patients. Deep brain stimulation (DBS) surgery is an FDA-approved treatment innovation for disabled PD patients, improving mobility and quality-of-life over and above the effects found using mainstay drug therapy. This research used the theory of reasoned action and the theory of planned behavior to examine antecedents to neurologists initiating a discussion of DBS surgery with a hypothetical PD patient. A national, cross-sectional mail survey (with online option) was conducted among a random sample of practicing U.S. neurologists. Participants totaled 86, for a response rate of 13.9%. Hierarchical linear regression showed that adding perceived behavioral control (PBC) to attitude and subjective norm resulted in significant ÄR2 = .22 in the prediction of intention. Of the two personal normative influences proposed as extensions to the TPB, adding moral norm resulted in a significant ÄR2 = .02, whereas role identity was non-significant. Mediation analyses showed that attitude partially mediated the effects of beliefs about the target, DBS surgery. PBC fully mediated perceived knowledge, whereas treatment benefit certainty was mediated partially by PBC. Implications for communication campaigns are discussed.
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    SURVEY ON THE STATE OF EVIDENCE-BASED MEDICINE IN MINNESOTA
    (2018-12-19) Aspinall, Erinn E; Hunt, Shanda L.; Sayre, Franklin D.; Theis-Mahon, Nicole R.; Chew, Katherine V.; Olawsky, Evan
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    What can physicians tell us about managed care tools?
    (2010-12) Davis, Margaret King
    Over the past three decades, physician-directed managed care tools have been used extensively by health plans to influence physician practice and control health care costs. The success of these tools varies widely as do the specifics of how they are implemented. Organizations involved in implementation of managed care tools are evolving, as are the tools themselves. Gaining insight into physicians' views on how managed care tools impact quality of care could help in the development of more effective tools. The purpose of this thesis is to address two questions regarding physicians' attitudes towards managed care tools: Do physicians practicing in the same clinics have similar views of managed care tools? Do physicians' views of managed care tools differ across practice settings and organizational structures (e.g., types of clinics and health plans)? Using the literature on physician job attitudes and sociological and economic theory to guide the investigation, these questions are addressed by looking at the effects of physician, clinic and health plan characteristics on physicians' attitudes toward managed care tools. Data for this study come from the PEHP survey of physicians in 15 health plans and 5 major cities nationwide with supplementary health plan information from Interstudy (1997). The data was collected in 1998-99. The initial sample of 4,800 physicians was stratified to be half generalists and half specialists. The overall response rate was 68% and N = 3,459. The first part of the analysis consists of structural equation modeling (SEM) to test the new typology of managed care tools. The scales developed in the first part are then used as dependent variables in a hierarchical linear modeling (HLM) analysis to explore the role of physicians' work setting and health plan affiliation on attitudes toward managed care tools. Results of the SEM indicate that managed care tools can be described and classified in terms of the types of control they exert on physicians. Results of the HLM analysis suggest that physicians practicing in the same clinic and health plans share some similar attitudes toward managed care tools, but the majority of differences are still at the physician level. Physician characteristics included in this study do not explain these differences, leaving open the question of whether the majority of variation is due to real differences in how individual physicians experience managed care tools, or due to measurement error. Future analysis could clarify this issue if clinic associations can be identified more accurately and/or better physician level predictors are developed.