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Factors affecting differences in Medicare reimbursements for physicians' services.

M Gornick, M Newton, C Hackerman

Health Care Financing Review

|January 6, 1981

Summary

Medicare Part B reimbursements for physician services varied widely in 1975 based on beneficiary demographics and geography. Factors like deductibles, allowed charges, and service utilization significantly impacted these variations.

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Area of Science:

Health Economics
Medical Care Policy

Background:

Medicare's Part B program covers physician services.
Reimbursement levels are influenced by beneficiary characteristics and service utilization.

Purpose of the Study:

Analyze variations in average Medicare Part B reimbursements per beneficiary for physicians' services in 1975.
Identify factors contributing to these reimbursement differences.

Main Methods:

Analysis of Medicare Part B reimbursement data from 1975.
Examination of demographic and geographic beneficiary characteristics.
Assessment of allowed charges and service utilization patterns.

Main Results:

Significant variations in average reimbursements per beneficiary were observed.

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Beneficiary demographics and geographic location were associated with reimbursement differences.

Allowed charges and the percentage of beneficiaries meeting the deductible influenced reimbursement levels.

Conclusions:

Medicare Part B reimbursement mechanisms in 1975 led to persistent, significant variations.
Existing cost-sharing and reimbursement structures are likely to continue these disparities.