IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v70y2010i2p191-198.html
   My bibliography  Save this article

Managed care and measuring medical outcomes: Did the rise of HMOs contribute to the fall in the autopsy rate?

Author

Listed:
  • Harrington, David E.
  • Sayre, Edward A.

Abstract

The U.S. autopsy rate has fallen precipitously since the 1940s, decreasing from 50 percent of bodies to less than eight percent today. Much of the decrease occurred after 1971 when hospitals were no longer required to do a minimum number of autopsies for accreditation. Since this time, major changes in the health care sector have occurred in the United States, highlighted by the increased importance of managed care. Using data for 46 states from 1987 to 2000, we analyze the degree to which the rise in manage care explains the decrease in the autopsy rate. We find that increases in health maintenance organization market share explain 21 percent of the decrease in the autopsy rate over the years from 1987 to 2000 and reductions in the number of hospital deaths explain another 30 percent. In contrast, we find that increases in the availability of magnetic resonance imaging had no significant effect on autopsy rates when other factors are held constant. Reforming health care financing to restrain the growth in health care costs using incentive mechanisms similar to those employed by managed care organizations has been a recurring policy goal in the United States. Our results imply that these reforms may inadvertently reduce the incentive to monitor medical outcomes using techniques such as autopsies, which is often called the "gold standard" in measuring medical outcomes.

Suggested Citation

  • Harrington, David E. & Sayre, Edward A., 2010. "Managed care and measuring medical outcomes: Did the rise of HMOs contribute to the fall in the autopsy rate?," Social Science & Medicine, Elsevier, vol. 70(2), pages 191-198, January.
  • Handle: RePEc:eee:socmed:v:70:y:2010:i:2:p:191-198
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(09)00609-1
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Mello, Michelle M. & Hemenway, David, 2004. "Medical malpractice as an epidemiological problem," Social Science & Medicine, Elsevier, vol. 59(1), pages 39-46, July.
    2. Gruber, Jonathan, 1994. "The effect of competitive pressure on charity: Hospital responses to price shopping in California," Journal of Health Economics, Elsevier, vol. 13(2), pages 183-211, July.
    3. Baker Laurence, 2000. "What Does HMO Market Share Measure? Examining Provider Choice Restrictions," Forum for Health Economics & Policy, De Gruyter, vol. 3(1), pages 1-24, January.
    4. Laurence Baker, 2000. "What Does HMO Market Share Measure? Examining Provider Choice Restrictions," NBER Chapters, in: Frontiers in Health Policy Research, Volume 3, pages 91-112, National Bureau of Economic Research, Inc.
    5. Gruber, Jonathan, 1994. "Erratum to "The effect of competitive pressure on charity: hospital responses to price shopping in California [Journal of Health Economics 13 (1994) 183-212]," Journal of Health Economics, Elsevier, vol. 13(4), pages 503-503.
    6. Town, Robert & Vistnes, Gregory, 2001. "Hospital competition in HMO networks," Journal of Health Economics, Elsevier, vol. 20(5), pages 733-753, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Rabbani, Maysam, 2021. "Mergers with Future Rivals Can Boost Prices, Intensify Market Concentration, and Bar Entry," MPRA Paper 112864, University Library of Munich, Germany, revised 26 Apr 2022.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hsien‐Ming Lien & Shin‐Yi Chou & Jin‐Tan Liu, 2010. "The Role Of Hospital Competition On Treatment Expenditure And Outcome: Evidence From Stroke And Cardiac Treatment In Taiwan," Economic Inquiry, Western Economic Association International, vol. 48(3), pages 668-689, July.
    2. Jomon A. Paul & Benedikt Quosigk & Leo MacDonald, 2019. "Factors Impacting Market Concentration of Not-for-Profit Hospitals," Journal of Business Ethics, Springer, vol. 154(2), pages 517-535, January.
    3. Tomas J. Philipson & Richard A. Posner, 2009. "Antitrust in the Not-for-Profit Sector," Journal of Law and Economics, University of Chicago Press, vol. 52(1), pages 1-18, February.
    4. Ge Bai, 2013. "How Do Board Size and Occupational Background of Directors Influence Social Performance in For-profit and Non-profit Organizations? Evidence from California Hospitals," Journal of Business Ethics, Springer, vol. 118(1), pages 171-187, November.
    5. Yip, Winnie C., 1998. "Physician response to Medicare fee reductions: changes in the volume of coronary artery bypass graft (CABG) surgeries in the Medicare and private sectors," Journal of Health Economics, Elsevier, vol. 17(6), pages 675-699, December.
    6. Mark Duggan, 2000. "Hospital Market Structure and the Behavior of Not-for-Profit Hospitals: Evidence from Responses to California's Disproportionate Share Program," NBER Working Papers 7966, National Bureau of Economic Research, Inc.
    7. Thanh An Nguyen Le & Anthony T. Lo Sasso, 2020. "Competition and market structure in the dental industry," International Journal of Health Economics and Management, Springer, vol. 20(2), pages 201-214, June.
    8. Currie, Janet & Fahr, John, 2004. "Hospitals, managed care, and the charity caseload in California," Journal of Health Economics, Elsevier, vol. 23(3), pages 421-442, May.
    9. Jill R. Horwitz & Austin Nichols, 2007. "What Do Nonprofits Maximize? Nonprofit Hospital Service Provision and Market Ownership Mix," NBER Working Papers 13246, National Bureau of Economic Research, Inc.
    10. Daysal, N. Meltem, 2012. "Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California," Journal of Health Economics, Elsevier, vol. 31(4), pages 545-563.
    11. Cory S. Capps & Dennis W. Carlton & Guy David, 2020. "Antitrust Treatment Of Nonprofits: Should Hospitals Receive Special Care?," Economic Inquiry, Western Economic Association International, vol. 58(3), pages 1183-1199, July.
    12. Currie, Janet & Gruber, Jonathan, 2001. "Public health insurance and medical treatment: the equalizing impact of the Medicaid expansions," Journal of Public Economics, Elsevier, vol. 82(1), pages 63-89, October.
    13. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    14. Mahmud Hassan & Gerard Wedig & Michael Morrisey, 2000. "Charity Care by Non-profit Hospitals: The Price of Tax-exempt Debt," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 7(1), pages 47-62.
    15. Peter Zaleski & Alfredo Esposto, 2007. "The Response to Market Power: Non-Profit Hospitals versus For-Profit Hospitals," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 35(3), pages 315-325, September.
    16. Levaggi, Rosella & Moretto, Michele & Pertile, Paolo, 2014. "Two-part payments for the reimbursement of investments in health technologies," Health Policy, Elsevier, vol. 115(2), pages 230-236.
    17. Janet Currie & Jonathan Gruber, 1997. "The Technology of Birth: Health Insurance, Medical Interventions, and Infant Health," NBER Working Papers 5985, National Bureau of Economic Research, Inc.
    18. Lauren Russell, 2021. "Price Effects of Nonprofit College and University Mergers," The Review of Economics and Statistics, MIT Press, vol. 103(1), pages 88-101, March.
    19. Kaestner, Robert & Guardado, Jose, 2008. "Medicare reimbursement, nurse staffing, and patient outcomes," Journal of Health Economics, Elsevier, vol. 27(2), pages 339-361, March.
    20. R. Konetzka & Edward Norton & Sally Stearns, 2006. "Medicare payment changes and nursing home quality: effects on long-stay residents," International Journal of Health Economics and Management, Springer, vol. 6(3), pages 173-189, September.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:70:y:2010:i:2:p:191-198. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.