title: The impact of physician involvement in managed care on efficient use of hospital resources.
abstract: OBJECTIVE
  This research assesses the impact of managed care on the physician's efficient use of hospital resources. It examines three questions. (1) Does a higher percentage and volume of managed care patients in the physician's hospital practice lead to more efficient utilization? (2) Do physicians shift cost to nonmanaged care patients in an effort to compensate for lower reimbursement for managed care patients? (3) Are there threshold effects in the percentage and volume of managed care patients treated by physicians?
  
  
  METHODS
  The study combines patient discharge data from the state of Arizona with physician and hospital data for a 2-year period. Random effects maximum likelihood (REML) regressions were performed for four different diagnosis classifications to examine the effect of the physician's managed care caseload on mean-adjusted charges and length of stay.
  
  
  RESULTS
  The findings suggest that physicians with high percentages and volumes of managed care patients in their hospital practice are more efficient in using hospital resources. The findings also suggest that physicians may compensate for the lower reimbursement from managed care patients by increasing their resource use among non-health maintenance organization patients.
  
  
  CONCLUSIONS
  Finally, there appears to be a threshold effect of managed care activity on the physician's hospital utilization in one of the conditions studied.
authors.affiliation: Department of Economics and Management, William E. Simon Graduate School of Business Administration, University of Rochester, NY 14627, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Van Horn
authors.forename: L R
authors.initials: LR
authors.lastname: Burns
authors.forename: D R
authors.initials: DR
authors.lastname: Wholey
mesh_terms: D001130:Arizona; D001291:Attitude of Health Personnel; D003361:Cost Allocation; D017598:Efficiency, Organizational; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D006302:Health Services Research; D017722:Hospital Charges; D018578:Hospital-Physician Relations; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D016013:Likelihood Functions; D008505:Medical Staff, Hospital / Q000523:psychology; D010351:Patient Discharge; D012051:Reimbursement Mechanisms; D016526:Workload