President Bush is trying to drag medicine into the 21st century. In recent weeks, he has touted a goal of making electronic health records available for most Americans within 10 years. The change would consolidate patients' medical histories, which currently are scattered among several doctors, and improve the ability of physicians to make correct diagnoses and prescribe proper treatments.
While many studies have shown that cyber-records can reduce errors, improve care and lower costs, the medical community is moving too slowly to adopt the new technology. Providers are loath to change their record-keeping ways because of concerns about the expense, fears about software glitches and a mind-set against radical departures in treating patients.
One important contribution of the current paper is to update the prior econometric work to the current managed care and policy environment, using a nationwide sample of medical groups responding to two surveys (1997 data) of the Medical Group Management Association: The Compensation and Production Survey and the Cost Survey. Second, the rich data set provided by the MGMA surveys allows us to account for the role of a variety of potential productivity "drivers" within the medical group: ownership form, presence of monitoring mechanisms, size of the group, physician specialty mix, and individual physician characteristics. Third, this research examines a wider range of ownership forms and specialty types of medical group practice-non-primary care single-specialty groups, primary care groups, and multispecialty groups--than previous empirical studies of physician productivity.
In contrast, the analyses of Gaynor and Pauly (1990) and Gaynor and Gertler (1995) were restricted to primary care groups and the partners hip form of practice. Fourth, by virtue of the broader array of specialty groups in the MGMA sample, the current study will be able to distinguish differential responses to financial incentives and organization design features among primary care physicians (PCPs), medical specialists, and surgical specialists.
