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Physician induced demand for knee replacement surgery in Iran
Cyrus Alinia1, Amirhossein Takian2,3,4, Nasser Saravi5
1Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
BMC Health Services Research
|August 3, 2021
Summary
Physician-induced demand (PID) significantly drives Knee Replacement Surgery (KRS) services in Iran. Increased surgeon supply led to more and larger surgeries, indicating potential overuse of costly procedures.
Area of Science:
- Health Economics
- Healthcare Policy
- Econometrics
Background:
- The Iranian health system's structure suggests Physician-Induced Demand (PID) may influence Knee Replacement Surgery (KRS) provision.
- Investigating the extent of PID in KRS services is crucial for understanding healthcare utilization patterns.
Purpose of the Study:
- To investigate the presence and impact of Physician-Induced Demand (PID) on Knee Replacement Surgery (KRS) services within the Iranian health system.
- To analyze the relationship between the supply of orthopedic surgeons and the volume and characteristics of KRS procedures.
Main Methods:
- Utilized unbalanced individual panel data of 15,729 KRS procedures from 995 surgeons (2014-2018).
- Employed a Generalized Method of Moments in a System (GMM-SYS) approach for dynamic panel data analysis.
- Examined provincial-level data on KRS volume, cost, and surgeon-to-population ratios.
Main Results:
- An increased orthopedic surgeon-to-population ratio significantly correlated with a higher number and larger size of KRS services (p<0.01).
- Positive elasticity for service size exceeded that for service number, strongly supporting PID in KRS.
- Knee Replacement Surgery volume, cost, and per-physician rates increased significantly at the monthly provincial level.
Conclusions:
- This study provides the first econometric evidence of PID in the Iranian health system concerning Knee Replacement Surgery.
- The Iranian health system's structure facilitates conditions conducive to PID for aggressive, high-cost, and high-risk procedures like KRS.
