The Efficiency of Medicare
The Efficiency of Medicare
复制标题
医疗保险的效率
DOI：
10.3386/w8395
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
J. Wennberg
中科院分区：
文献类型：
--
作者：
J. Skinner;E. Fisher;J. Wennberg
医疗保健的技术进步已被证明为美国老年人口带来了巨大的平均健康效益。然而，人们对医疗保健支出的边际或增量效益知之甚少。我们使用医疗保健支出的地理差异来衡量老年医疗保险人群中更大的医疗保健强度的边际价值。为了纠正反向因果关系问题--病情较重的地区往往需要更多的医疗保健--我们使用生命最后六个月内医生就诊的地区平均数作为医疗保健强度的自然随机化。使用线性和半参数工具变量，我们发现医疗保险支出的一大部分-以1996年美元计算为260亿美元，或近20%的医疗保险总支出-似乎在生存方面没有提供任何好处，也不太可能这些额外的支出改善生活质量。虽然医疗保健技术的长期趋势带来了巨大的健康益处，但在某个时间点上，医疗保健强度的变化却没有。
Technological advances in health care have been shown to yield large average health benefits for the U.S. elderly population. However, less is known about the marginal or incremental benefits of health care spending. We use geographical variations in health care spending to measure the marginal value of greater health care intensity among the elderly Medicare population. To correct for the reverse causation problem -- that sicker areas tend to require more health care -- we use regional averages of physician visits in the last six months of life as a natural randomization for health care intensity. Using linear and semiparametric instrumental variables, we find that a large component of Medicare expenditures -- $26 billion in 1996 dollars, or nearly 20 percent of total Medicare expenditures -- appears to provide no benefit in terms of survival, nor is it likely that this extra spending improves the quality of life. While secular trends in health care technology have delivered large health benefits, variation in health care intensity at a point in time have not.