Heterogeneity and Share Contracting in Medical Group Practices

This paper offers an empirical analysis of the relationship between income sharing rules and physician heterogeneity in medical group practices.The economies to group formation associated with risk-sharing, mutual monitoring,and internal referral are served by sharing at least a portion of group income equally. Sharing group income equally is problematic, however, when group members differ in their contribution to group income. Member contributions to group income may differ because of differences in ability, effort, or the price of services across specialty fields. The analysis below is addressed to the question of how income sharing rules in physician groups are affected by variation in member contributions. The analysis finds evidence that heterogeneity in member contributions to group income limits the use of equal income sharing rules in multispecialty groups relative to single specialty groups, and large groups relative to small groups. Nevertheless, 65% of all groups in the survey share at least a pn of group income equally, which broadly suggests that the joint surplus enhancement from risk sharing, mutual monitoring, and internal referral are sufficient to overcome the incentive problems of such rules