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Patterns of Pediatric Practice by the Same Physicians in a Prepaid and a Fee- for-Service Setting

How the Organization of the Delivery of Health Services Influences Physician Behavior

Division of Health Care Research, and the Departments of Medicine, Preventive Medicine, and Pediatrics, Washington University School of Medicine, St. Louis, Mo

Anita Mackie

Division of Health Care Research, and the Departments of Medicine, Preventive Medicine, and Pediatrics, Washington University School of Medicine, St. Louis, Mo

Lawrence Kahn

Division of Health Care Research, and the Departments of Medicine, Preventive Medicine, and Pediatrics, Washington University School of Medicine, St. Louis, Mo

Gerald T. Perkoff

Division of Health Care Research, and the Departments of Medicine, Preventive Medicine, and Pediatrics, Washington University School of Medicine, St. Louis, Mo

A study is reported of the ambulatory services provided by four pediatricians who practice both in their own fee-for-service practice (FFS) and in an experimental prepaid group practice model (PPGP). Differences were noted in the two prac tices. There were more infants in the fee-for- service practice and more adolescents in the pre paid practice. Likewise, a nurse provided follow- up medical services in the prepaid practice but not in the fee-for-service practice. These factors explained some of the results observed. Even allowing for these practice differences, however, the same physicians prescribed more laboratory tests, consultations, and follow-up visits in the prepaid as opposed to the fee-for-service prac tice. This study suggests that observed differences in medical care utilization between PPGP and FFS are associated with the organizational, staffing, and financial aspects of prepaid practice contrasted to fee-for-service practice, rather than with physician differences per se.

Clinical Pediatrics, Vol. 13, No. 4, 352-359 (1974)
DOI: 10.1177/000992287401300417


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