Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending
Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending
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DOI：
10.1257/pol.20150421
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发表时间：
2019-02-01
影响因子：
5.3
通讯作者：
Wennberg, David
中科院分区：
文献类型：
--
作者：
Cutler, David;Skinner, Jonathan S.;Wennberg, David
关于卫生保健支出地区差异的原因存在相当大的争议。本研究使用与医疗保险费用相关的患者和医生调查的小插曲，询问患者需求方因素或医生供应方因素是否解释了这些变化。结果表明，病人的需求是相对不重要的解释变化。医生的组织因素很重要，但最重要的因素是医生对治疗的信念。在医疗保险中，我们估计35%的临终关怀支出和12%的心脏病发作患者（以及所有登记者）支出与临床证据不支持的医生信念有关。
There is considerable controversy about the causes of regional variations in health care expenditures. Using vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures, this study asks whether patient demand-side factors or physician supply-side factors explain these variations. The results indicate that patient demand is relatively unimportant in explaining variations. Physician organizational factors matter, but the most important factor is physician beliefs about treatment. In Medicare, we estimate that 35 percent of spending for end-of-life care and 12 percent of spending for heart attack patients (and for all enrollees) is associated with physician beliefs unsupported by clinical evidence.