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Unhealthy Trends: The Future of Physician Services

Health Affairs Article: Most Trends Point to Higher Costs and Greater Tiering of Access by Ability to Pay

Media Advisory
Nov. 1, 2007

Alwyn Cassil (202) 264-3484 or

WASHINGTON, DC—Left unchecked, most trends in how physicians organize and practice medicine are likely to lead to higher spending and declining access to care for lower-income people, according to an article by Center for Studying Health System Change (HSC) researchers in the November/December Health Affairs.

"Physicians are moving into larger practices and loosening affiliations with general hospitals; providing more ancillary services; and investing in enterprises that compete with hospitals for outpatient, or even inpatient, services," write Hoangmai H. Pham, M.D., M.P.H, a senior HSC researcher, and Paul Ginsburg, Ph.D, president of HSC, a nonpartisan policy research organization funded primarily by the Robert Wood Johnson Foundation.

"Some of these developments may be undesirable if they lead to overuse of services or questionable quality of care….More physician services are subject to self-referral incentives. And the payment system has not evolved to support changes in practice, such as additional care coordination, to treat a growing number of patients with multiple chronic diseases," according to the article.

The authors also point to the steady decline in the proportion of physicians willing to care for uninsured and Medicaid patients, writing that, "More disturbingly, current trends in the delivery of physician services may contribute to an increasingly tiered delivery system. Physician-owned facilities are less likely than general hospitals to serve Medicaid beneficiaries or the uninsured. The increasing prevalence of physicians opting to drop contracts with insurers to receive higher out-of-network payments from patients will contribute further to disparities in access to providers. And to the extent that spending on physician services contributes to rising costs, this will exacerbate the decline in employer-based coverage and growth in patient cost sharing, both of which disproportionately affect low-income people."

The authors note, however that "other trends may be desirable, such as growing expectations that physicians will make evidence-based care decisions. And physicians’ increasing use of health information technology (IT) may facilitate system-level approaches to improve care delivery."

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.