Interpretive Structural Modeling of the Factors Affecting Induced Demand for Health Services

Document Type : Original Article

Authors

1 Student Research Committee, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of management, Shiraz University, Shiraz,Iran

Abstract

Introduction: Induced demand is an important challenge in national healthcare systems, and can waste their resources. The likelihood of induced demand and the intensity of its effects are the results of an interaction between a wide range of factors. Therefore, this study was designed for structural modeling of the factors affecting induced demand.
Method(s): This applied study was carried out using a descriptive-analytic design. First, the factors affecting induced demand were identified by a thorough literature review. Then, using interpretive structural modeling (ISM), the relationship between the factors was determined and categorized, and the final model  developed. In addition, using MICMAC analysis, the types of variables have been identified with respect to their driving and dependency power.
Results: Lack of clinical guidelines, increased number of providers, weakness of education system, weakness of Health Supervisory System, poor supervision of insurance companies, improper payment system, providers' insufficient knowledge, skills and clinical uncertainty, defensive medicine, patient preferences, information asymmetry, the collusion of service providers, and their incentives to earn more income were identified as the most important factors affecting management and control of induced demand.
Conclusion: Induced demand reduction requires finding the relationships between the key factors to provide a clear framework for determining the best controlling policies, thereby preventing the loss of healthcare resources. This study provided a new insight into the factors affecting induced demand leading to prioritization of decision-making and policymaking measures.

Keywords

References

1. Rezapoor A, Ebadifard Azar F. Situation of resource allocation in Iranian, s health system. Journal of Hospital. 2013;11(4):53-64.
2. Panahi H, Fallahu F, Imani A, Nasibparast S. Investigating Psychiatrists Induced Demand in East Azarbayjan: The Approach of Hierarchical Linear Modeling (HLM). Journal of Economic Modeling Research. 2018;8(31):165-96. doi: 10.29252/jemr.8.31.165.
3. Ahmadi A, Taheri E. Factors affecting health expenditures of households in Iran: application of Ordered Probit model. Journal of Health Administration. 2017;20(67):89-98.
4. Golkhandan A, Fatholahi E. Offering and Testing a Model to Explain the Physician Induced Demand in Iran. Journal of Healthcare Management (Journal of Health System). 2017;7(4):29-40.
5. Cawley J, Moriya AS, Simon K. The impact of the macroeconomy on health insurance coverage: Evidence from the great recession. Health economics. 2015;24(2):206-23.
6. Khorasani E, Karimi S, Keyvanara M, Etemadi M, Khorasani F. Identification of the healthcare services with potential induced demand. International Journal of Hospital Research. 2015;4(2):47-54.
7. Keyvanara M, Karimi S, Khorasani E. Jafarian jazi M. Challenges resulting from healthcare induced demand: a qualitative study. Health Inf Manage. 2013;10(4):548.
8. Shain M, Roemer MI. Hospital costs relate to the supply of beds. Journal of Occupational and Environmental Medicine. 1959;1(9):518.
9. Romer MI. Bed supply and hospital utilization: A national experiment. Hospitals, JAH A. 1961;1961(35):988-93.
10. Nassiri A, Rochaix L. Revisiting phy sicians’ financial incentives in Quebec: a panel system approach. Health Econ. 2006;15(1):49-64. doi: 10.1002/hec.1012.
11. Panahi H, Salmani B, Nasibparast S. Inductive effect of physicians number and hospital bed on health expenditures in Iran. Quarterly Journal of Applied Theories of Economics. 2015;2(2):25-42.
12. Sekimoto M, Ii M. Supplier-Induced Demand for Chronic Disease Care in Japan: Multilevel Analysis of the Association between Physician Density and Physician-Patient Encounter Frequency. Value Health Reg Issues. 2015;6:103-10. doi: 10.1016/j.vhri.2015.03.010.
13. Yuda M. Medical fee reforms, changes in medical supply densities, and supplier-induced demand: Empirical evidence from Japan. Hitotsubashi Journal of Economics. 2013:79-93.
14. Grytten J, Carlsen F, Skau I. The income effect and supplier induced demand. Evidence from primary physician services in Norway. Applied Economics. 2001;33(11):1455-67.doi: 10.1080/00036840010009883.
15. Mahbubi M, Ojaghi S, Ghiyasi M, Afkar A. Supplemental insurance and induce demand in veterans. Med Veterans J. 2010;2(8):18-22.
16. Crivelli L, Filippini M, Mosca I. Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons. Health Econ. 2006;15(5):535-41. doi: 10.1002/hec.1072.
17. Varharami V. Evaluation of the Physician Induced Demand. J Healthcare Manage. 2010;2:3742.
18. Ayre C, Scally AJ. Critical values for Lawshe’s content validity ratio: revisiting the original methods of calculation. Measurement and Evaluation in Counseling and Development. 2014;47(1):79-86.
19. Borhanzade A. Induced demand and the cost of tests and its impact on cost and family health. Iranian Association of Clinical Laboratory Doctors. 2011;11(1):17-22.
20. Johnson E, Culyer A. Physician-Induced Demand. Encyclopedia of Health Economics. Elsevier. 2014;3:77-82.doi: 10.1016/b978-0-12- 375678-7.00805-1.
21. Karimi S, Khorasani E, Keyvanara M, Afshari S. Factors affecting physicians’ behaviors in induced demand for health services. International Journal of Educational and Psychological Researches. 2015;1(1):43. doi: 10.4103/2395-2296.147469.
22. Keyvanara M, Karimi S, Khorasani E. Opinions of health system experts about main causes of induced demand: A qualitative study. Hakim Research Journal. 2014;16(4):317-28.
23. Khani M. Investigating Physician Induced Demand (Case Study: CSection in Iran). Faculty of Management and Economics: University of Sharif; 2013. Persian.
24. Khorasani E, Keyvanara M, Karimi S, Jazi MJ. Views of health system experts on macro factors of induced demand. Int J Prev Med. 2014;5(10):1286-98.
25. Riahi M, Molavi Taleghani Y, Salehiniya H, Vejdani M. Induced demand: A challenge on the way of Iran Health Revolution Program. Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2016;7(5):1827-35.
26. Ahmed J, Shaikh B. The many faces of supplier induced demand in health care. Iranian Journal of Public Health. 2009:139-41.
27. Mahmoudi G, Roohi G, Asadi M, Kalamaki FR, Abam S, Khojamli M, et al. Factors associated with induced demand for services in Iran’s healthcare system. F1000Research. 2018;7(978):978.
28. Mohamadloo A, Ramezankhani A, Zarein-Dolab S, Salamzadeh J, Mohamadloo F. A systematic review of main factors leading to irrational prescription of medicine. Iran J Psychiatry Behav Sci. 2017;11(2):e10242. deoi: 10.5812/ijpbs.10242.
29. Pedersen LB, Hess S, Kjaer T. Asymmetric information and user orientation in general practice: Exploring the agency relationship in a best-worst scaling study. J Health Econ. 2016;50:115-30. doi: 10.1016/j.jhealeco.2016.09.008.
30. Broomberg J, Price MR. The impact of the fee-for-service reimbursement system on the utilisation of health services. Part I. A review of the determinants of doctors’ practice patterns. S Afr Med J. 1990;78(3):130-2.
31. De Jaegher K, Jegers M. A model of physician behaviour with demand inducement. J Health Econ. 2000;19(2):231-58. doi: 10.1016/s0167-6296(99)00029-6.
32. Delattre E, Dormont B. Fixed fees and physicianinduced demand: a panel data study on French physicians. Health Econ. 2003;12(9):741-54. doi: 10.1002/hec.823.
33. Grossman M. The human capital model. Handbook of health economics. 2000; 1: 347–408.doi: 10.1016/s15740064(00)80166-3.
34. Hansen BB, Sørensen TH, Bech M. Variation in utilization of health care services in general practice in Denmark. University of Southern Denmark, Institute of Public Health–Health Economics. 2008.
35. Izumida N, Urushi H, Nakanishi S. An empirical study of the physician-induced demand hypothesis: The cost function approach to medical expenditure of the elderly in Japan. Rev Popul Soc Policy. 1999;8:11-25.
36. Keyvanara M, Karimi S, Khorasani E, Jazi MJ. Experts’ perceptions of the concept of induced demand in healthcare: A qualitative study in Isfahan, Iran. J Educ Health Promot. 2014;3:27. doi: 10.4103/2277-9531.131890.
37. Labelle R, Stoddart G, Rice T. A re-examination of the meaning and importance of supplierinduced demand. J Health Econ. 1994;13(3):347-68. doi: 10.1016/0167-6296(94)90036-1.
38. Noguchi H, Shimizutani S. Supplier-induced demand in Japan’s at-home care industry: Evidence from micro-level survey on care receivers. Dublin: Economic and Social Research Institute; 2005.
39. Tunis SR. Economic analysis in healthcare decisions. American Journal of Managed Care. 2004;10(5):301-4.
40. van Dijk CE, van den Berg B, Verheij RA, Spreeuwenberg P, Groenewegen PP, de Bakker DH. Moral hazard and supplier-induced demand: empirical evidence in general practice. Health Econ. 2013;22(3):340-52. doi: 10.1002/hec.2801.
41. Keyvanara M, Karimi S, Khorasani E, Jafarian Jazi M. Are Health Institutions Involved In Health Care Induced Demand?(A Qualitative Study). Payavard Salamat. 2014;8(4):280-93.
42. Amporfu E. Private hospital accreditation and inducement of care under the ghanaian national insurance scheme. Health Econ Rev. 2011;1(1):13. doi: 10.1186/2191-1991-1-13.
43. Bickerdyke I, Dolamore R, Monday I, Preston R. Supplier-induced demand for medical services. Canberra: Productivity Commission Staff Working Paper. 2002:1-113.
44. Falit BP, Gross CP, Roberts KB. Integrated prostate cancer centers and over-utilization of IMRT: a close look at fee-for-service medicine in radiation oncology. Int J Radiat Oncol Biol Phys. 2010;76(5):1285-8. doi: 10.1016/j. ijrobp.2009.10.060.
45. Ansari B, Bahadori M, Hosseini S. Determinats of Reduction of Induced Demand Inselected Hospitals That Affiliated with IUMS in 2017; A Qualitative Stady On Provider’s View. The J Urmia Nurs Midwifery Fac. 2018;16(6):389-402.
46. Gruber J, Owings M. Physician financial incentives and cesarean section delivery. Rand J Econ. 1996;27(1):99-123.
47. Hemani ML, Makarov DV, Huang WC, Taneja SS. The effect of changes in Medicare reimbursement on the practice of office and hospital-based endoscopic surgery for bladder cancer. Cancer. 2010;116(5):1264-71. doi: 10.1002/cncr.24875.
48. Madden D, Nolan A, Nolan B. GP reimbursement and visiting behaviour in Ireland. Health Econ. 2005;14(10):1047-60. doi: 10.1002/hec.995.
49. Sada MJ, French WJ, Carlisle DM, Chandra NC, Gore JM, Rogers WJ. Influence of payor on use of invasive cardiac procedures and patient outcome after myocardial infarction in the United States. Participants in the National Registry of Myocardial Infarction. J Am Coll Cardiol. 1998;31(7):1474-80. doi: 10.1016/s0735-1097(98)00137-5.
50. Bazyar M, Soofi M, Rashidian A. Ways to control moral hazard in health system: demand-side and supply-side interventions. Tolooebehdasht. 2012;11(1):110-22. doi: 10.1007/s12513-012-0142-x.
51. Darzi RS, Shahnazi R, Niakan L, Kavosi Z. Physician-Induced Demand Hypothesis in Iran: Impact of the Physician Density on Treatment Costs. Sanaat-E-Bimeh. 2018;32(4):1-19.
52. Karimi S, Rezaei F, Kordi A. Utilization of magnetic resonance imaging in patient covered by Isfahan health care insurance, Iran. Director General. 2013;9(7):1146-51.
53. Kung PT, Tsai WC, Yaung CL, Liao KP. Determinants of computed tomography and magnetic resonance imaging utilization in Taiwan. Int J Technol Assess Health Care. 2005;21(1):81-8. doi: 10.1017/s0266462305050105.
54. Leonard C, Stordeur S, Roberfroid D. Association between physician density and health care consumption: a systematic review of the evidence. Health Policy. 2009;91(2):121-34. doi: 10.1016/j.healthpol.2008.11.013.
55. Lien HM, Albert Ma CT, McGuire TG. Providerclient interactions and quantity of health care use. J Health Econ. 2004;23(6):1261-83. doi: 10.1016/j.jhealeco.2004.03.003.
56. Richardson JRJ, Peacock S. Supplier induced demand reconsidered. New Jersey: Citeseer; 1999.
57. Tsai W-C, Kung P-T, Liao K-P. The impact of physician supply on the utilization of ambulatory care under the National Health Insurance. Mid-Taiwan Journal of Medicine. 2004;9(1):27-37.
58. Yip WC. Physician response to Medicare fee reductions: changes in the volume of coronary artery bypass graft (CABG) surgeries in the Medicare and private sectors. J Health Econ. 1998;17(6):675-99. doi: 10.1016/s0167-6296(98)00024-1.
59. Bremberg S, Nilstun T. Justifications of physicians’ choice of action. Scand J Prim Health Care. 2005;23(2):102-8. doi: 10.1080/02813430510018455.
60. Espeland A, Baerheim A. Factors affecting general practitioners’ decisions about plain radiography for back pain: implications for classification of guideline barriers--a qualitative study. BMC Health Serv Res. 2003;3(1):8. doi: 10.1186/1472-6963-3-8.
61. Khorasani E, Keyvanara M, Karimi S, JAFARIAN JM. The Role of Patients in Induced Demand from Experts’perception: A Qualitative Study. Journal of Qualitative Research in Health Sciences. 2014;2(4):336-45. doi: 10.4103/2347-9019.138931.
62. Wilson IB, Dukes K, Greenfield S, Kaplan S, Hillman B. Patients’ role in the use of radiology testing for common office practice complaints. Arch Intern Med. 2001;161(2):256-63. doi: 10.1001/archinte.161.2.256.
63. Coenen S, Michiels B, Renard D, Denekens J, Van Royen P. Antibiotic prescribing for acute cough: the effect of perceived patient demand. Br J Gen Pract. 2006;56(524):183-90.
64. Dosoretz AM. Reforming Medicare IMRT (intensity modulated radiation therapy) reimbursement rates: A study investigating increasing IMRT utilization rates and doctors’ incentives: Tufts University; 2011.
65. Mao W, Tang S, Chen W. Does perverse economic incentive lead to the irrational uses of medicines? Expert Rev Pharmacoecon Outcomes Res. 2013;13(6):693-6. doi: 10.1586/14737167.2013.856266.
66. Simbar M, Nahidi F, Tehrani FR, Ramezankhani A. Fathers’ educational needs for perinatal care in urban Iran: a qualitative approach. J Biosoc Sci. 2010;42(5):633-41. doi: 10.1017/S0021932010000167.
67. Yousefi N, Majdzadeh R, Valadkhani M, Nedjat S, Mohammadi H. Reasons for physicians’ tendency to irrational prescription of corticosteroids. Iran Red Crescent Med J. 2012;14(11):713-8. doi: 10.5812/ircmj.2284.
68. Amiresmaili M, Nekoueimoghadam M, Moosazadeh M, Esmaili F, Mirtajeddini M. A survey on frequency of defensive medicine among general practitioners of Kerman city. Journal of Payavard Salamat. 2014;7(5):399-409.
69. Iversen T, Luras H. The effect of capitation on GPs’ referral decisions. Health Econ. 2000;9(3):199-210.
doi: 10.1002/(sici)1099-1050(200004)9:3<199::aidhec514>3.0.co;2-2.
70. Mohr JC. American medical malpractice litigation in historical perspective. JAMA. 2000;283(13):1731-7. doi: 10.1001/jama.283.13.1731.
71. Studdert DM, Mello MM, Brennan TA. Medical malpractice. N Engl J Med. 2004;350(3):283-92. doi: 10.1056/NEJMhpr035470.
72. Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293(21):2609-17. doi: 10.1001/jama.293.21.2609.
73. Summerton N. Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ. 1995;310(6971):27-9. doi: 10.1136/bmj.310.6971.27.
74. Tussing AD, Wojtowycz MA. Malpractice, defensive medicine, and obstetric behavior. Med Care. 1997;35(2):172-91. doi: 10.1097/00005650-199702000-00007.
Health Management & Information Science
Volume 7, Issue 2
April 2020
Pages 107-116

Files

Share

How to cite

Statistics