PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of hsresearchLink to Publisher's site
 
Health Serv Res. 2000 October; 35(4): 825–848.
PMCID: PMC1089155

HMO growth and the geographical redistribution of generalist and specialist physicians, 1987-1997.

Abstract

OBJECTIVE: To assess the impact of the growth in HMO penetration in different metropolitan areas on the change in the number of generalists, specialists, and total physicians, and on the change in the proportion of physicians who are generalists. DATA SOURCES/STUDY SETTING: The American Medical Association Physician Masterfile, to obtain the number of patient care generalists and specialists in 1987 and in 1997 who were practicing in each of 316 metropolitan areas in the United States. Additional data for each metropolitan area were obtained from a variety of sources, and included HMO penetration in 1986 and 1996. STUDY DESIGN: We estimated multivariate regression models in which the change in the number of physicians between 1987 and 1997 was a function of HMO penetration in 1986, the change in HMO penetration between 1986 and 1996, population characteristics and physician fees in 1986, and the change in population characteristics and fees between 1986 and 1996. Each model was estimated using ordinary least squares (OLS) and two-stage least squares (TSLS). PRINCIPAL FINDINGS: HMO penetration did not affect the number of generalist physicians or hospital-based specialists, but faster HMO growth led to smaller increases in the numbers of medical/surgical specialists and total physicians. Faster HMO growth also led to larger increases in the proportion of physicians who were generalists. Our best estimate is that an increase in HMO penetration of .10 between 1986 and 1996 reduced the rate of increase in medical/surgical specialists by 10.3 percent and reduced the rate of increase in total physicians by 7.2 percent. CONCLUSIONS: The findings of this study support the notion that HMOs reduce the demand for physician services, particularly for specialists' services. The findings also imply that, during the past decade, there has been a redistribution of physicians-especially medical/surgical specialists-from metropolitan areas with high HMO penetration to low-penetration areas.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Baker LC. The effect of HMOs on fee-for-service health care expenditures: evidence from Medicare. J Health Econ. 1997 Aug;16(4):453–481. [PubMed]
  • Dranove D, Simon CJ, White WD. Determinants of managed care penetration. J Health Econ. 1998 Dec;17(6):729–745. [PubMed]
  • Escarce JJ, Polsky D, Wozniak GD, Pauly MV, Kletke PR. Health maintenance organization penetration and the practice location choices of new physicians: a study of large metropolitan areas in the United States. Med Care. 1998 Nov;36(11):1555–1566. [PubMed]
  • Gold MR, Hurley R, Lake T, Ensor T, Berenson R. A national survey of the arrangements managed-care plans make with physicians. N Engl J Med. 1995 Dec 21;333(25):1678–1683. [PubMed]
  • Goldberg LG, Greenberg W. The determinants of HMO enrollment and growth. Health Serv Res. 1981 Winter;16(4):421–438. [PMC free article] [PubMed]
  • Hadley J, Mitchell JM. Effects of HMO market penetration on physicians' work effort and satisfaction. Health Aff (Millwood) 1997 Nov-Dec;16(6):99–111. [PubMed]
  • Miller RH, Luft HS. Managed care plan performance since 1980. A literature analysis. JAMA. 1994 May 18;271(19):1512–1519. [PubMed]
  • Porell FW, Wallack SS. Medicare risk contracting: determinants of market entry. Health Care Financ Rev. 1990 Winter;12(2):75–85. [PubMed]
  • Remler DK, Donelan K, Blendon RJ, Lundberg GD, Leape LL, Calkins DR, Binns K, Newhouse JP. What do managed care plans do to affect care? Results from a survey of physicians. Inquiry. 1997 Fall;34(3):196–204. [PubMed]
  • Shea JA, Kletke PR, Wozniak GD, Polsky D, Escarce JJ. Self-reported physician specialties and the primary care content of medical practice: a study of the AMA physician masterfile. American Medical Association. Med Care. 1999 Apr;37(4):333–338. [PubMed]
  • Simon CJ, Dranove D, White WD. The effect of managed care on the incomes of primary care and specialty physicians. Health Serv Res. 1998 Aug;33(3 Pt 1):549–569. [PMC free article] [PubMed]
  • Weiner JP. Forecasting the effects of health reform on US physician workforce requirement. Evidence from HMO staffing patterns. JAMA. 1994 Jul 20;272(3):222–230. [PubMed]
  • Welch WP. HMO enrollment: a study of market forces and regulations. J Health Polit Policy Law. 1984 Winter;8(4):743–758. [PubMed]
  • Wholey D, Feldman R, Christianson JB. The effect of market structure on HMO premiums. J Health Econ. 1995 May;14(1):81–105. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust