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Physicians' charges under Medicare: assignment rates and beneficiary liability
Health Care Financing Review
|December 7, 1980
Summary
Physicians accepting Medicare assignment reduce patient costs. In 1975, assignment rates varied, and beneficiaries bore significant out-of-pocket expenses, including premiums, deductibles, and coinsurance.
Area of Science:
- Health Economics
- Medical Policy
- Public Health
Background:
- Medicare's Part B program allows physicians to accept assignment for claims.
- Accepting assignment means physicians agree to Medicare's allowed charge as full payment.
- Physician acceptance of assignment significantly impacts beneficiary financial burden.
Purpose of the Study:
- To analyze the importance of physician assignment acceptance in Medicare.
- To examine beneficiary liabilities including premiums, deductibles, and coinsurance.
- To detail variations in assignment acceptance rates.
Main Methods:
- Analysis of physician claims data for services rendered in 1975.
- Calculation of beneficiary liability as a percentage of total physician charges.
Main Results:
- In 1975, 45.8% of services and 47.2% of charges were assigned for the aged.
- Significant variations in assignment acceptance were observed across physician specialties and beneficiary demographics (age, race, residence).
- Beneficiary liability (deductible, coinsurance, unassigned claims) was 37.7% of charges; including premiums, it rose to 69.2%.
Conclusions:
- Physician assignment acceptance is crucial for mitigating Medicare beneficiary costs.
- Beneficiary out-of-pocket expenses, including premiums and cost-sharing, represent a substantial financial liability.
- Understanding variations in assignment rates is key to addressing healthcare affordability.