Physician Induced Demand: The Empirical Evidence of  Angiography for Suspected Coronary Artery Disease

Marita  Mohammadshahi; Sara  Emamgholipour; Alireza  Olyaeemanesh; Minoo Alipouri Sakha; Ali Akbari  Sari; Shahrooz  Yazdani

doi:10.18502/ijph.v53i1.14699

Marita Mohammadshahi Department of Health Economics, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
Sara Emamgholipour Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Teh-ran, Iran
Alireza Olyaeemanesh Department of Health Economics, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
Minoo Alipouri Sakha Department of Health Education and Promotion, Deputy of Health, Iran University of Medical Sciences, Tehran, Iran
Ali Akbari Sari Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Teh-ran, Iran
Shahrooz Yazdani Department of Cardiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

DOI: https://doi.org/10.18502/ijph.v53i1.14699

Keywords: Supplier induced demand; Physician ethic index; Angiography; Coronary artery disease; Risk score; Insurance; Econometric model

Abstract

Background: We aimed to investigate the existence of unnecessary demand for angiography and the factors affecting it to provide evidence for decision makers.

Methods: This longitudinal panel study was conducted in public hospitals in Tehran, Iran by using 2458 patients' records that were undergoing angiography for suspected coronary artery disease 2013-2015. To modeling the physicians' behavior based on physician-induced demand (PID), the patients were classified as appropriate, uncertain, and inappropriate and then Hierarchical Linear Modeling (HLM) model besides the physician ethic index was developed and finally the existence of PID showed based on three scenarios.

Results: Angiographies were performed inappropriately in 23.8% of 2458 patients as well 46.7% were uncertain, and 29.5% were appropriate. According to the HLM model, the physician-to-population ratio (δ0= -0.161) and the interaction variable coefficient are higher than zero and significant (δ1 = 253). The results of the physician ethic index showed that most physicians were at a moderate rate, meaning that their utility was a combination of both pecuniary and non-pecuniary profits (0│> ε_pδ│ <1). Considering the HLM model and the medical ethics index together has almost shown the condition of PID (the necessary condition δ1> 0 and the sufficient condition (1 ≤│ε_pδ│)( existed for about 26% of all studied physicians who had pure profit maximizer.

Conclusion: To reduce induced demand and improve medical ethics adherence in cardiologist, policy makers should develop native guidelines, rules, and instructions besides policies related to education, and increasing patients' awareness.