Abstract：
This study explores the variation in specialist physician fees and examines whether the variation can be attributed to patient risk factors, variation between physicians, medical specialties, or other factors. We use health insurance claims data from a large private health insurer in Australia. Although Australia has a publicly funded health system that provides universal health coverage, about 44 % of the population holds private health insurance. Specialist physician fees in the private sector are unregulated; physicians can charge any price they want, subject to market forces. We examine the variation in fees using two price measures: total fees charged and out-of- pocket payments. We follow a two-stage method of removing the influence of patient risk factors by computing risk-adjusted prices at patient-level, and aggregating the adjusted prices over all claims made by each physician to arrive at physician-level average prices. In the second stage, we use variance-component models to analyse the variation in the physician-level average prices. We find that patient risk factors account for a small portion of the variance in fees and out-of-pocket payments. Physician-specific variation accounts for the bulk of the vari- ance. The results underscore the importance of understanding physician characteristics in formulating policy efforts to reduce fee variation.
摘要：
这项研究探讨了专科医师费用的变化，并检查了这种变化是否可以归因于患者的风险因素。医生之间的差异，医学专业,或其他因素。我们使用澳大利亚一家大型私人健康保险公司的健康保险索赔数据。尽管澳大利亚有一个公共资助的卫生系统，提供全民健康覆盖，大约44%的人口持有私人医疗保险。私营部门的专科医师费用不受监管；医生可以收取他们想要的任何价格，受制于市场力量。我们使用两种价格衡量标准来检查费用的变化：收取的总费用和自付费用。我们遵循两阶段方法，通过计算患者级别的风险调整价格来消除患者风险因素的影响，并汇总每个医生提出的所有索赔的调整后价格，以得出医生级别的平均价格。在第二阶段,我们使用方差-成分模型来分析医师级平均价格的变化.我们发现，患者风险因素占费用和自付费用差异的一小部分。医生特定的变异占变异的大部分。结果强调了了解医生特征在制定减少费用变化的政策努力中的重要性。
