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Medicare balance billing restrictions: Impacts on physicians and beneficiaries

  • McKnight, Robin

Recent publicity about “concierge physicians” has raised concerns about the potential adverse effects of allowing physicians to bill their patients for fees that are above normal copayments and insurance reimbursements. In particular, consumers who are unable to afford the additional costs of such physicians are concerned that their access to highquality medical care could be compromised. Such concerns in the context of Medicare led states and the federal government, beginning in the late 1980s, to restrict the ability of physicians to “balance bill” beneficiaries for charges in excess of the copayment and reimbursement amounts approved by Medicare. In this paper, I provide empirical evidence that this policy change resulted in an 8% reduction in out-of-pocket medical expenditures by elderly households. In spite of the change in marginal reimbursement to physicians, however, I find little evidence that the restrictions affected quantity or quality of care.

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File URL: http://www.sciencedirect.com/science/article/B6V8K-4M33VSY-1/2/10c3d4484916746a854d2fe26589780e
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Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 26 (2007)
Issue (Month): 2 (March)
Pages: 326-341

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Handle: RePEc:eee:jhecon:v:26:y:2007:i:2:p:326-341
Contact details of provider: Web page: http://www.elsevier.com/locate/inca/505560

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  1. Yelowitz, Aaron S., 2000. "Public policy and health insurance choices of the elderly: evidence from the medicare buy-in program," Journal of Public Economics, Elsevier, vol. 78(3), pages 301-324, November.
  2. Mitchell, Janet B. & Cromwell, Jerry, 1982. "Physician behavior under the medicare assignment option," Journal of Health Economics, Elsevier, vol. 1(3), pages 245-264, December.
  3. Glazer, Jacob & Glazer, Jacob & McGuire, Thomas G., 1993. "Should physicians be permitted to 'balance bill' patients?," Journal of Health Economics, Elsevier, vol. 12(3), pages 239-258, October.
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