Doctoral Dissertation Research in Economics: Essays on the determinants of healthcare differences in US hospitals

经济学博士论文研究：美国医院医疗保健差异的决定因素论文

• 批准号: 1227608
• 负责人: Douglas Almond
• 金额: $ 0.54万
• 依托单位: Columbia University
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1227608&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Economics; Essays

Healthcare differences are pervasive in United States hospitals. This proposal aims to understand why patients with the same underlying health conditions receive different treatments, incur different costs, and experience different outcomes. There are conceivably many factors that affect patient care, but one factor may be the quality of the patient's attending physician, and another factor may be the patient's health insurance category. The first project in this proposal asks whether physician characteristics explain differences in patient treatments, costs, and outcomes. It focuses on patients who visit Florida emergency rooms (ER) from 2005-2009 and who are assigned to ER physicians. It aims to answer questions previously unaddressed in the literature, such as whether physician experience and medical school explain differences in patient care. ERs are meaningful laboratories for analysis, as ER visits have increased over time and ERs provide healthcare to underserved populations. This project has the ability to advance the field of knowledge on physicians, while also generating implications for how healthcare services are delivered to a large subset of the population.The second project asks how changes in federal funding affect Medicaid program enrollment, spending, and hospital care. In 2011, Federal Medical Assistance Percentages (FMAPs) decreased for all states as the American Recovery and Reinvestment Act expired. In response, states tried to reduce Medicaid spending by adjusting provider payments. This project uses data from California, Florida, and New York to determine how Medicaid enrollment, spending, and hospital utilization changed in response to changes in federal funding. It is important to determine how federal funding affects the quality of healthcare Medicaid patients receive. Understanding the consequences of the FMAP will give policy-makers more information about how counties and hospitals might respond to changes going forward.

医疗保健差异在美国医院普遍存在。该提案旨在了解为什么具有相同基础健康状况的患者接受不同的治疗，产生不同的成本，并经历不同的结果。可以想象，有许多因素影响病人的护理，但一个因素可能是病人的主治医生的质量，另一个因素可能是病人的健康保险类别。本提案中的第一个项目询问医生特征是否可以解释患者治疗、成本和结果的差异。它的重点是病人谁访问佛罗里达急诊室（ER）从2005年至2009年，谁被分配到ER医生。它的目的是回答以前在文献中未解决的问题，如医生的经验和医学院是否解释病人护理的差异。急诊室是有意义的分析实验室，因为急诊室的访问随着时间的推移而增加，急诊室为服务不足的人群提供医疗保健。这个项目有能力推进医生的知识领域，同时也产生了医疗保健服务是如何提供给一个大的子集population.The第二个项目的影响如何改变联邦资金影响医疗补助计划的注册，支出和医院护理。2011年，随着《美国复苏和再投资法案》的到期，所有州的联邦医疗援助费用都有所减少。作为回应，各州试图通过调整提供者的付款来减少医疗补助支出。该项目使用来自加州、佛罗里达和纽约的数据来确定医疗补助计划的注册、支出和医院利用率如何随着联邦资金的变化而变化。重要的是要确定联邦资金如何影响医疗补助病人接受的医疗质量。了解FMAP的后果将为政策制定者提供更多关于县和医院如何应对未来变化的信息。