Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-09T08:01:14.507Z Has data issue: false hasContentIssue false

Economic Incentives and the Distribution of Extracorporeal Shock wave Lithotripters and Linear Accelerators in Spain

Published online by Cambridge University Press:  10 March 2009

Pablo Lázaro
Affiliation:
Instituto de Salud Carlos III
Kathryn Fitch
Affiliation:
Instituto de Salud Carlos III

Abstract

We studied the role of economic incentives for private providers in explaining Spain's disproportionately large number of extracorporeal shock wave lithotripters (ESWLs) and low number of linear accelerators (linacs) per million population (pmp) in comparison to other countries of the Organization for Economic Cooperation and Development (OECD). We found that the reimbursement policy for 1990 allowed an average profit per private ESWL of $732,000, but no profit for linacs. Regional per-capita income was positively correlated with ESWLs pmp in Spain (R2 = 0.49; p =.001), but not with linacs. Sixty-nine percent of ESWLs were privately held versus only 16% of linacs. To avoid these types of distortions, financial incentives should be based on a reasonable relationship between cost and charges and should be associated with the appropriateness of medical care.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Vizcaya, Banco Bilbao. Informe económico 1991. Bilbao: A. G. Rontegui, S.A.L., 1994, 165.Google Scholar
3.Carlsson, P., Tiselius, H., & Borch, K. Some aspects on extracorporeal shock wave lithotripsy for renal and biliary stone treatment. CMTRapport, 1991, 35 (report prepared for the World Health Organization, Division of Noncommunicable Disease and Health Technology).Google Scholar
4.Chassin, M., Kosecoff, J., Park, R., et al. Does inappropriate use explain geographic variations in the use of health care services? A study of three procedures. Journal of the American Medical Association, 1987, 258, 2533–37.CrossRefGoogle ScholarPubMed
5.Epstein, A., Begg, C., & McNeil, B.The use of ambulatory testing in prepaid and fee-for-service group practices. New England Journal of Medicine, 1986, 314, 1089–94.CrossRefGoogle ScholarPubMed
6.Goddard, M., & Hutton, J.The costs of radiotherapy in cancer treatment. York: University of York, Centre for Health Economics, 10 1988, 19.Google Scholar
7.Gray, D., Hampton, J., Bernstein, S., et al. Audit of coronary angiography and bypass surgery. Lancet, 1990, 335, 1317–20.CrossRefGoogle ScholarPubMed
8.Hemenway, D., Killen, A., Cashman, S., et al. Physicians' responses to financial incentives: Evidence from a for-profit ambulatory care center. New England Journal of Medicine, 1990, 322, 1059–63.CrossRefGoogle ScholarPubMed
9.Herschberg, S.Potential conflicts of interest in the delivery of medical services: An analysis of the situation and a proposal. Quality Assurance Utilization Review, 1991, 7, 5458.CrossRefGoogle Scholar
2.Bernstein, S., Kosecoff, J., Gray, D., et al. The appropriateness of the use of cardiovascular procedures. International Journal of Technology Assessment in Health Care, 1993, 9, 310.CrossRefGoogle ScholarPubMed
10.Hillman, B., Joseph, C., Mabry, D., et al. Frequency and costs of diagnostic imaging in office practice: A comparison of self-referring and radiologist-referring physicians. New England Journal of Medicine, 1990, 323, 1604–08.CrossRefGoogle Scholar
11.Hillman, B., Olson, G., Griffith, P., et al. Physicians' utilization and charges for outpatient diagnostic imaging in a medicare population. Journal of the American Medical Association, 1992, 268, 2050–54.CrossRefGoogle Scholar
12.Instituto Nacional de Estadistica. Anuario estadistico 1993 [Annual statistical report — 1993, in Spanish]. Madrid: INE, 1994, 518.Google Scholar
13.Instituto Nacional de la Salud, Ministerio de Sanidad y Consumo. Tarifas de los servicios sanitarios prestados a pacientes no beneficiarios de la Seguridad Social en centros hospitalarios y centros de atención primaria [Fees for health services provided to patients not covered by Social Security in primary care hospitals and centers, in Spanish]. Madrid: INSALUD, 01 30, 1990, internal document.Google Scholar
14.Lazaro, P., & Fitch, K.The distribution of ‘big ticket’ medical technologies in OECD countries. International Journal of Technology Assessment in Health Care, 1995, 11, 551–69.CrossRefGoogle ScholarPubMed
15.Mays, N.Relative costs and cost-effectiveness of extracorporeal shock-wave lithotripsy versus percutaneous nephrolithotomy in the treatment of renal and ureteric stones. Social Science and Medicine, 1991, 32, 1401–12.CrossRefGoogle ScholarPubMed
16.Ministerio de Sanidad y Consumo. Cáncer en España [Cancer in Spain, in Spanish). Madrid: Ministerio de Sanidad y Consumo, 1993, 106.Google Scholar
17.Organization of Economic Cooperation and Development. OECD health data: A software package for the international comparison of health care systems, version 1.0. Paris: OECD, 1991.Google Scholar
18.Swedlow, A., Johnson, G., Smithline, N., & Milstein, A.Increased costs and rates of use in the California workers' compensation system as a result of self-referral by physicians. New England Journal of Medicine, 1992, 327, 1502–06.CrossRefGoogle ScholarPubMed