The Impact of Legal and Regulatory Policy on Patient and Provider Decision Making

法律和监管政策对患者和提供者决策的影响

• 批准号: 9709612
• 负责人: Daniel Kessler
• 金额: $ 34.64万
• 依托单位: National Bureau of Economic Research Inc
• 依托单位国家: 美国
• 项目类别: Continuing Grant
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-07-01 至 2001-06-30
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=9709612&HistoricalAwards=false
• 关键词: Impact; Legal; Regulatory; Policy; Patient

Kessler 9709612 This research will investigate empirically the impact of legal an regulatory policy and physician decision making and the consequences of law-induced changes in health care decision for health care costs and patient health care outcomes. To date, none of the methods used the in the published literature have been based on datasets that would allow direct measurement of all of the key variables hypothesized to have causal relations among the law, physician and patient treatment decisions, health care costs, and health outcomes. Three studies will remedy this problem. The first project estimates the impact of medical malpractice liability law reforms on defensive medicine. It explores the why and how doctors practice defensive medicine. The second estimates the impact of living wills on medical treatment, costs, and outcomes at the end of life. The third estimates the impact of hospital competition on the cost and quality of medical care. Three types of data will be used. Medicare Part A and Part B claims forms and matching Social Security death date records have been linked in analytic files. Information regarding covered services, discharge information, and demographic informant are included. In addition, an ongoing project on Treatment Intensity and Outcomes of major illness data set guides the living will subproject. The longitudinal files span 1984-1993 and are updated regularly. The analyses will use data from 100 percent of Medicare beneficiaries who have ever had a particular illness will use 20% random sample of other beneficiaries as a comparison group. Medstat data will provide information on claims records for over 4 million nonelderly employees, dependents, and retirees with firm medical plans. National hospital information datasets will be used as well. %%% This research will investigate empirically the impact of legal an regulatory policy and physician decision making and the consequences of law-induced changes in health care decision for health care costs and patient health care outcomes. To date, none of the methods used the in the published literature have been based on datasets that would allow direct measurement of all of the key variables hypothesized to have causal relations among the law, physician and patient treatment decisions, health care costs, and health outcomes. Three studies will remedy this problem. The first project estimates the impact of medical malpractice liability law reforms on defensive medicine. It explores the why and how doctors practice defensive medicine. The second estimates the impact of living wills on medical treatment, costs, and outcomes at the end of life. The third estimates the impact of hospital competition on the cost and quality of medical care. Three types of data will be used. Medicare Part A and Part B claims forms and matching Social Security death date records have been linked in analytic files. Information regarding covered services, discharge information, and demographic informant are included. In addition, an ongoing project on Treatment Intensity and Outcomes of major illness data set guides the living will subproject. The longitudinal files span 1984-1993 and are updated regularly. The analyses will use data from 100 percent of Medicare beneficiaries who have ever had a particular illness will use 20% random sample of other beneficiaries as a comparison group. Medstat data will provide information on claims records for over 4 million nonelderly employees, dependents, and retirees with firm medical plans. National hospital information datasets will be used as well. ***

凯斯勒 9709612本研究将从经验上调查法律的监管政策和医生决策的影响，以及法律引起的医疗保健决策变化对医疗保健成本和患者医疗保健结果的影响。 到目前为止，在已发表的文献中使用的方法都没有基于数据集，可以直接测量所有假设在法律，医生和患者治疗决策，医疗保健成本和健康结果之间存在因果关系的关键变量。 三项研究将解决这一问题。 第一个项目评估医疗事故责任法改革对防御性医疗的影响。 它探讨了医生为什么以及如何实践防御性医学。 第二个估计的影响，生前遗嘱的医疗，成本和结果在生命的尽头。 第三部分估计了医院竞争对医疗服务成本和质量的影响。 将使用三种数据。 医疗保险A部分和B部分索赔表以及匹配的社会保障死亡日期记录已链接到分析文件中。 包括有关承保服务、出院信息和人口统计信息提供者的信息。 此外，一个正在进行的关于重大疾病治疗强度和结果数据集的项目指导了生前遗嘱子项目。 纵向档案涵盖1984-1993年，并定期更新。 这些分析将使用100%曾患有特定疾病的医疗保险受益人的数据，并将使用20%的其他受益人作为对照组。Medstat数据将提供超过400万名非老年雇员、家属和退休人员的索赔记录信息。 还将使用国家医院信息数据集。 本研究将实证调查法律的监管政策和医生决策的影响，以及法律引起的医疗保健决策变化对医疗保健成本和患者医疗保健结果的影响。 到目前为止，在已发表的文献中使用的方法都没有基于数据集，可以直接测量所有假设在法律，医生和患者治疗决策，医疗保健成本和健康结果之间存在因果关系的关键变量。 三项研究将解决这一问题。 第一个项目评估医疗事故责任法改革对防御性医疗的影响。 它探讨了医生为什么以及如何实践防御性医学。 第二个估计的影响，生前遗嘱的医疗，成本和结果在生命的尽头。 第三部分估计了医院竞争对医疗服务成本和质量的影响。 将使用三种数据。 医疗保险A部分和B部分索赔表以及匹配的社会保障死亡日期记录已链接到分析文件中。 包括有关承保服务、出院信息和人口统计信息提供者的信息。 此外，一个正在进行的关于重大疾病治疗强度和结果数据集的项目指导了生前遗嘱子项目。 纵向档案涵盖1984-1993年，并定期更新。 这些分析将使用100%曾患有特定疾病的医疗保险受益人的数据，并将使用20%的其他受益人作为对照组。Medstat数据将提供超过400万名非老年雇员、家属和退休人员的索赔记录信息。 还将使用国家医院信息数据集。 ***