Do market fees differ from relative value scale fees? Examining surgeon payments in New Zealand

摘要

Objectives: Health funders face the challenge of determining the appropriate level of surgeon fees in fee-for-nservice schemes. A resource-based relative value scale (RBRVS) attempts to identify the fees that would existnin a competitive market. Private insurance providers in New Zealand do not use a RBRVS but rather rely onna market. We explore the extent to which private surgeon fees in New Zealand are consistent with fees thatnwould be generated by a RBRVS.nMethods: Data on 155,290 surgical procedures from 2004–06 were provided by New Zealand’s largest privatenhealth insurer. 314 procedure codes were matched to the Australian Ministry of Health and Ageing’s RBRVS.nA random effects model determined predicted surgeon reimbursements based on the RBRVS, the locationnand the year. Procedure volume and specialty were explored as potential sources of deviations.nResults: The RBRVS, location and year explain 79% of the variation in surgeon fees. After accounting for thenRBRVS, location and year, no statistical differences were found between five out of the seven specialties, butnhigher volume procedures were associated with lower fees. There was some evidence that the modelnexplained less variation in lower volume procedures.nConclusions: Surgical fees were generally consistent with those predicted by the RBRVS. However, the fees fornhigh volume procedures were relatively lower than predicted while the fees for low volume procedures appearednmore variable. The findings are consistent with the hypothesis that market forces lowered prices for proceduresnwith higher volumes. This has implications for how health funders might determine private surgical fees,nespecially in mixed public-private systems.