Physician Behavior Under the Medicare Assignment Option

摘要

Policymakers have become increasingly concerned over the growing number of physicians who are unwilling to accept Medicare patients on assignment. The national sample of general practitioners, internists, and general surgeons confirmed this reluctance: Over one-quarter (28.2%) of survey physicians stated that they never accept assignment of any of their patients; a smaller number (18.9%) report that they always do. The remaining physicians pick and choose their assigned patients on a case by case basis. Econometric analysis showed that assignment rates were very sensitive to reimbursement and administrative practices under Medicare. A ten percent increase in the prevailing charge, for example, raised assignment by 14.7 percent. Higher carrier rates of reduction and higher claims denial and investigation rates significantly depressed assignment. The assigned and nonassigned components of the Medicare program were found to compete with each other; assignment rates were lower where the demand for nonassigned services was stronger. As for the kinds of physicians who take assignment, they were disproportionately general surgeons and foreign medical graduates.