High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency
High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency
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DOI：
10.1377/hlthaff.2016.1266
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发表时间：
2017-05-01
期刊：
影响因子：
9.7
通讯作者：
McWilliams, J. Michael
中科院分区：
文献类型：
--
作者：
Roberts, Eric T.;Mehrotra, Ateev;McWilliams, J. Michael
医生做法的合并加剧了人们的担忧，即与市场力量较小的提供者相比，市场力量较大的提供者可能能够收取更高的价格，而不必提供更好的护理。提供者认为，更高的价格涵盖了提供更高质量护理的成本。我们研究了门诊服务的医生执业价格与执业质量和护理效率之间的关系。使用商业索赔数据，我们将做法分为高价或低价。我们使用了来自医疗保健提供者和系统调查的消费者评估的国家数据，并将医疗保险受益人的索赔联系起来，以比较同一地理区域在护理质量，利用率和支出方面的高价和低价做法。与低价做法相比，高价做法的规模要大得多，价格高出36%。高价格的做法的患者在护理协调和管理的一些措施的得分显着较高，但没有显着差异，在他们的整体护理评级，其他领域的病人的经验（包括医生评级和获得护理），接受预防服务，急性护理使用，或总医疗保险支出。这表明，实践价格和护理的质量和效率之间的关系总体较弱，并质疑高价提供者提供高价值护理的说法。
Consolidation of physician practices has intensified concerns that providers with greater market power may be able to charge higher prices without having to deliver better care, compared to providers with less market power. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and practices' quality and efficiency of care. Using commercial claims data, we classified practices as being high-or low-price. We used national data from the Consumer Assessment of Healthcare Providers and Systems survey and linked claims for Medicare beneficiaries to compare high- and low-price practices in the same geographic area in terms of care quality, utilization, and spending. Compared with low-price practices, high-price practices were much larger and received 36 percent higher prices. Patients of high-price practices reported significantly higher scores on some measures of care coordination and management but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of preventive services, acute care use, or total Medicare spending. This suggests an overall weak relationship between practice prices and the quality and efficiency of care and calls into question claims that high-price providers deliver substantially higher-value care.