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Blue Shield plan physician participation.

D E Yett, W Der, R L Ernst

Health Care Financing Review

|January 6, 1982

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Physician participation in health insurance plans increases with higher fees but lower-quality physicians are more likely to join. This creates a trade-off between cost containment and access to quality care in government health insurance programs.

Area of Science:

Health Economics
Physician Behavior
Healthcare Policy

Background:

Physician participation agreements in Blue Shield Plans often resemble Medicaid provisions.
Understanding physician decisions is crucial for healthcare policy and program effectiveness.

Purpose of the Study:

To examine physician participation decisions in Blue Shield Plans with all-or-nothing agreements.
To identify factors influencing physicians' willingness to join insurance plans.

Main Methods:

Analysis of physician participation based on fee schedules and physician characteristics.
Comparative study of two Blue Shield Plans with specific agreement structures.

Main Results:

Increased plan fees significantly correlate with a higher probability of physician participation.

Related Experiment Videos

Physicians with characteristics deemed "low quality" are more likely to participate than "high quality" physicians.

Conclusions:

Restricting physician fees to control costs may reduce participation, potentially limiting access to quality care for program beneficiaries.
A balance is needed between cost containment and ensuring physician availability in government health insurance programs.