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Date:
March 14, 2002
Time: 11:00 - 12:15
Venue: G05 Patrick Manson Building (South Wing), 7 Sassoon Road,
Pokfulam, HKU
Microeconomics
has long been used to explain physicians' behaviour. Health care
delivery and financing nowadays have become very elaborate. Increasingly,
clinicians are asked to report on patients before referrals are
approved, treatments authorized, or insurance claims processed.
Although these myriad of procedures may have been installed for
cost containment or quality enhancement purposes, clinicians often
find them interfering with care delivery while patients regard them
as rationing mechanisms. As reactions, clinicians sometimes have
to make strategic decisions about what to report and omit to insurer
and payers. The existing health literature has already pointed out
that gaming, sincere reporting, nudging, and dodging the rules by
providers are important (Morreim HE, 1991. Archives of Internal
Medicine. 151:443-447).
In
this study, the authors report a unique data set for studying gaming;
our focus is on alcohol treatment programs in the state of Maine,
USA. They compare two reports made by a clinician on a patient.
One report is used by the Maine Office of Substance Abuse (OSA)
to evaluate provider performance; the second is an actual clinical
record. This is perhaps the first study in which two reports made
by the same clinician are examined directly. This allows us to assess
directly the extent of gaming. The motives of physician's mis-reporting,
i.e. financial motive and altruistic
motive are explained.
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