Physician Response to a Change in Medicaid FeesMcKay, N. L.; Dorner, F. H.
doi: 10.1177/095148489901200201pmid: 10537614
This study examines the effects of a change in Medicaid fees on the volume of physician services provided to beneficiaries. The data set includes price and volume at the procedure-level for Medicaid physician services in Texas in 1991, 1993, and 1995. The empirical analysis compares the volume of services provided to Medicaid participants before and after a 1992 change in reimbursement method. The results indicate that, over the period 1991 to 1993, the change in Texas Medicaid physician fees did not have a statistically significant effect on the volume of services provided. When measured over a longer period of time (1991–1995), however, volume increased significantly when price decreased, but, when price increased, there was no significant effect on volume. The results thus provide empirical support for the behavioural offset assumption underlying the switch to Medicare's Resource-Based Relative Value Scale (RBRVS) method of physician payment. A key policy implication is that reduced fees did not lead to a lower volume of physician services provided to Medicaid patients at least over the period of analysis. However, the new Medicaid fee schedule did not have the desired effect of controlling Medicaid expenditures on physician services.
Level of Analysis Considerations in Organizational Citizenship Behaviour Research: An Empirical Investigation of Individual and Work Group Effects among Hospital EmployeesBolon, D. S.
doi: 10.1177/095148489901200203pmid: 10537616
An implicit assumption in previous research is that the relationship between job satisfaction and organizational citizenship behaviour is an individual level phenomenon. However, due to the use of raw score correlation-based or related analyses, previous investigations have not shown empirical support for the individual level of analysis. This study empirically tested several relationships between job satisfaction (including facets) and a specific type of citizenship behaviour in order to determine whether such relationships were relevant for individuals or for the entire work group. Results indicate an overall lack of group-based effects. Instead, individual-difference effects represent the significant relationships found in the data. Several null effects were also obtained. These results go beyond the traditional approach to organizational citizenship behaviour research because group-based relationships have been explicitly rejected rather than simply assumed to be unimportant. Evidence for individual-differences was provided by testing for levels of analysis effects in terms of individuals and work groups. Future research should assess the generalizability of these results by including tests for levels of analysis.
Implementing Information Technology in the NHS: The Role of NarrativeBrown, A. D.
doi: 10.1177/095148489901200204pmid: 10537612
This paper analyses how groups use narratives in social processes of sensemaking and identity construction and in the pursuit and legitimation of their selfish interests. It does so through an examination of the narrativity of the experiences reported by the developers and users of an information technology (IT) system linking a haematology laboratory and a specialist haematology ward in a large acute hospital. The research contribution the paper makes is twofold. First, it illustrates the importance of group-level narratives in enacting organizational realities and especially in the social construction of IT systems. Second, it suggests that the narrative understanding of groups is a significant domain of organizational inquiry because it is through the spread and acceptance of their narratives that groups exercise their most profound influence.
Cross-National Comparison of Capitation Funding: The American, British and Dutch ExperiencePersaud, D.; Narine, L.
doi: 10.1177/095148489901200205pmid: 10537613
In this paper we review the performance of the capitation payment systems of three countries—he Adjusted Average Per Capita Cost (AAPCC) system used in the United States to reimburse Health Maintenance Organizations (HMOs) for insuring Medicare recipients, a somewhat similar system in the Netherlands which reimburses third-party payers for insuring the entire population and a weighted system utilized in Britain for regional funding.Our review revealed significant problems with the current version of the AAPCC formula as there is evidence of the biased selection of beneficiaries and actual losses to Medicare through its use. Furthermore, several studies show that the demographic adjusters utilized in the AAPCC formula are extremely poor predictors of future healthcare utilization relative to the potential of direct and indirect health status measures. The Dutch experience with capitated funding has been similar to that of the United States. While Dutch researchers have built on the work of their American counterparts they acknowledge that further work is needed before a fully functional system is implemented. Britain's weighted system has fulfilled its original mandate to redistribute healthcare resources based on population need but recent changes giving increased influence to age weighting could reverse some of these gains.A number of proposed improvements to these risk adjustment problems were reviewed including the development of diagnostic cost groups, the coexisting hierarchical conditions model and the use of community-rated high-risk pooling. The findings from this study can help others narrow the alternatives they need to consider when thinking of introducing capitation funding or refining already existing systems.