Priority access to health care: Evidence from an exogenous policy shock.
Priority access to health care: Evidence from an exogenous policy shock.
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DOI：
10.1002/hec.3982
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发表时间：
2020-03
期刊：
影响因子：
2.1
通讯作者：
Pizer S
中科院分区：
文献类型：
--
作者：
Yee CA;Legler A;Davies M;Prentice J;Pizer S
获得护理是公共卫生保健系统中的一个重要问题。与价格平衡供需的私人系统不同，公共系统通常通过等待时间来配给医疗服务。以先到先得的方式提供的访问可能无法产生最大化人群健康的资源分配，从而可能在等待时间中产生次优的异质性。在这项研究中，我们检查了两组患者（既定患者和新患者）之间的访问差异。我们利用由美国退伍军人健康管理局实施的外生政策变化，消除了差异并使等待时间均质化。我们发现强有力的证据表明，如果没有这样的政策，老患者将比新患者优先获得服务。我们讨论这是否是次优的资源分配。我们还发现，已建立的患者优先访问权是新患者获得访问权的重要决定因素；考虑到这一点，我们的新患者等待时间统计模型的解释力提高了五倍。研究结果表明，如果明确认识并考虑访问异质性，政策和管理决策可能会更有效地实现访问的最佳分配。
Access to care is an important issue in public health care systems. Unlike private systems, in which price equilibrates supply and demand, public systems often ration medical services through wait times. Access that is given on a first come, first served basis might not yield an allocation of resources that maximizes the health of a population, potentially creating suboptimal heterogeneity in wait times. In this study, we examine an access disparity between two groups of patients—established patients and new patients. We exploit an exogenous policy change—implemented by the U.S. Veterans Health Administration—that removed the disparity and homogenized the wait time. We find strong evidence that without such a policy, established patients have priority access over new patients. We discuss whether this is a suboptimal allocation of resources. We additionally find that established patient priority access is an important determinant of access for new patients; accounting for it increased the explanatory power of our statistical model of new patient wait times by a factor of five. The findings imply that policy and management decisions may be more effective in achieving the optimal distribution of access if access heterogeneity is recognized and accounted for explicitly.
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