Specialization by Physicians Contributed to Inefficiency in

¶ … specialization by physicians contributed to inefficiency in healthcare? Research conducted by Dartmouth economics instructors Katherine Baicker and Amitabh Chandra indicates that areas of the United States that have "…relatively more medical specialists" tend to have "higher spending per Medicare beneficiary" and yet those areas do not produce "higher quality care," or more satisfaction, or even "lower mortality" (Baicker, et al., 2004).

The initial pertinent question raised by the researchers: a) is a higher density of doctor specialization in healthcare markets linked to "higher-quality healthcare?" The first part of the answer is that when there is increased specialization in a healthcare area it is linked to the fact that patients see more doctors (Baicker, 359). In areas where there are say, eight more medical specialists per 100,000 people -- and 8 fewer family practitioners -- those areas have "…50% more beneficiaries seeing more than 10 doctors in the last six months of life" (Baicker, 359).

Given the additional number of medical specialists, one would surmise that better healthcare and better health outcomes would be the result, Baicker continues. But, more doctor specialists also bring the potential for "increased coordination failures." Moreover, if those specialists do not "internalize the coordination cost they impose on other physicians," or if subsidies lead to a policy of patients seeing too many specialists, then those areas that have "increased specialization may not have better care" (Baicker, 359).

In conclusion, Baicker says the bottom line is the consumer may not be benefitting from an increased number of doctors who specialize. In fact areas that have more specialists "…spend more on healthcare for Medicare beneficiaries but see no improvement in the quality of care, mortality, or patient satisfaction" (Baicker, 360). Essay #2: Managed care and its effects on physician patient relationships. A report in the National Institutes of Health (PubMed.gov) attempted to survey the views of 1,011 primary physicians in the State of Pennsylvania when it comes to managed care.

The doctors were asked about how physician-patient relationships are impacted by managed care, about the ability of physicians to carry out their professional "ethical obligations," and about how the "quality of patient care" is impacted, if at all. Of those 1,011 doctors, the response rate was 55%, and most of the participants agreed that in managed care situations "…physicians are less able to avoid conflicts of interest," and respondents also indicated that doctors are "less able to place the best interests of patients first" (Feldman, et al., 1998).

A majority of doctors participating in the survey indicated that with managed care, the quality of healthcare offered is compromised by: a) "limitations in location of diagnostic tests"; b) "length of hospital stay"; and c) "choice of specialists" (Feldman, p. 1). A "minority" (between 27% and 49%) also said it is more difficult to carry out "ethical obligations," to respect the "autonomy" of patients, and to respect "confidentiality" when it comes to doctor-patient conversation (Feldman, p. 1).

The conclusion that the researchers reached after this survey was analyzed was that "many physicians" believe managed care has "significant effects" on the relationships between the patient and the doctor,.