CAREER: Empirical Studies of Incentive Design, Information Technology Use, and Productivity in Physician Markets

激励设计，信息技术的使用和生产力在医生市场的实证研究医疗保健成本的增长是美国目前面临的主要政策问题之一：17.4%的美国国内生产总值是专门用于医疗保健支出，而43%的所有卫生支出来自联邦，州和地方政府。虽然鉴于保健服务的潜在价值，高支出是合理的，但最近的研究表明，可以减少支出，而不会对健康产生负面影响。2010年的《平价医疗法案》大大增加了获得医疗保健的机会，但几乎没有包含应对成本增长挑战的条款。当前促进高效医疗保健支出的政策方法包括（i）消费者成本分担（ii）卫生技术评估（iii）医生支付改革和（iv）改善IT的使用。 该项目旨在提高我们对如何以成本效益高的方式改善人口健康的认识。它侧重于更好地理解（一）医生如何应对提供优质医疗保健的经济激励措施，以及（二）医生的治疗如何应对复杂的IT工具的可用性。尽管了解这些医疗提供者的行为的重要性，有这些主题的研究有限。该项目利用独特的数据，并采用经济学中的尖端方法，以促进我们对这些领域的医生和患者行为的科学理解。这些研究进展应直接影响以具有成本效益的方式改善国民健康和福祉的政策。 除了这一研究方面，该项目将为卫生经济学研究生设立一个讲习班，旨在促进全面了解在这一领域进行原创性研究所需的科学技术。这次研讨会将汇集来自全国各地的领先卫生经济学家，培养博士。学生在卫生经济学和卫生政策。拟议和拟议的研讨会将产生更广泛的影响，不仅仅是科学进步，包括医疗保健领域的政策影响和培训新一代卫生经济学家的专业影响。在研究方面，该项目调查了几个新的大规模数据集，这些数据集详细跟踪了医生行为和患者行为。第一个要研究的环境是夏威夷医疗服务协会（HMSA），它是夏威夷州最大的保险公司。HMSA实施了一系列最先进的质量激励计划，以鼓励医生提供更高质量的医疗服务。此外，2012年，卫生和医疗服务部牵头在全系统实施了一个复杂的信息技术工具，为医生提供关于其质量表现的具体实时信息。在这些自然实验的背景下，有详细的管理数据（i）超过700，000名患者的患者行为和特征，以及（ii）超过1，000名医生的医生行为和特征。关键的微观层面的信息，观察医生如何应对质量激励措施和使用现有的IT，无论是之前和之后HMSA实施具体的关键变化。PI将利用这些微观层面的数据来调查与医生培训相关的异质性效应、医生治疗的患者概况以及医生组织的特征。该分析将被用来调查如何从结构上提高医生的质量激励和使用IT的目标更高的质量和更具成本效益的医疗保健。第二个将被调查的环境是缅因州医疗中心，该中心与技术合作伙伴AgileMD合作实施移动的技术，帮助其200多名医生治疗复杂的医疗状况。在这种情况下，PI将使用随机评价以及关于医生行为和IT使用的详细数据，研究移动的技术对生产力的作用。 该研究计划使用经济学中的尖端方法以及新颖的数据集来研究关键的知识问题，这些问题将增强我们对重要政策领域经济学的理解。除了这一知识价值外，该项目还将通过其影响的政策和培训新一代卫生经济学家的讲习班产生更广泛的影响。

Empirical Studies of Incentive Design, Information Technology Use and Productivity in Physician MarketsHealth care cost growth is one of the central policy problems the U.S. currently faces: 17.4% of U.S. GDP is devoted to health care spending while 43% of all health spending comes from federal, state, and local governments. While high spending can be justified given the potential value of health services, recent research indicates that spending could be reduced without negatively affecting health. The Affordable Care Act of 2010 greatly increased access to health care but included few provisions to meet the cost growth challenge head on. Current policy approaches to facilitate efficient health care spending include (i) consumer cost-sharing (ii) health technology assessment (iii) physician payment reform and (iv) improved use of IT. This project seeks to advance our understanding of how to improve population health in a cost-effective manner. It focuses on better understanding (i) how physicians respond to financial incentives for providing quality health care and (ii) how physician treatments respond to the availability of sophisticated IT tools. Despite the importance of understanding these medical provider behaviors, there is limited research on these topics. The project leverages unique data and employs cutting edge methods in economics to advance our scientific understanding of physician and patient behaviors in these domains. These research advances should have direct implications for policies that seek to improve national health and well-being in a cost-effective manner. In addition to this research dimension, the project will set up a workshop for graduate students in health economics designed to promote a comprehensive understanding of the scientific techniques necessary to make advances in this field in original research. This workshop will bring together leading health economists from across the country to train Ph.D. students in both health economics and health policy. Both the proposed and proposed workshop will have broader impacts beyond just the scientific advances, including policy impacts in the space of health care and professional impacts in training a new generation of health economists. On the research side, this project investigates several new large-scale datasets that track both physician behaviors and patient behaviors in detail. The first environment to be studied is the Hawaii Medical Service Association (HMSA), the largest insurer in the state of Hawaii. HMSA has implemented a range of state-of-the-art quality incentive programs to encourage physicians to provide higher quality medical care. In addition, in 2012 HMSA led the system-wide implementation of a sophisticated IT tool that provides physicians with specific real-time information on their quality performance. In the context of these natural experiments, there are detailed administrative data on (i) patient behaviors and characteristics for over 700,000 patients and (ii) physician behaviors and characteristics for over 1,000 physicians. Key micro-level information are observed on exactly how physicians respond to quality incentives and use available IT, both before and after HMSA implemented specific key changes. The PI will leverage these micro-level data to investigate heterogeneous effects related to physician training, the profile of patients a physician treats, and characteristics of physician organizations. The analysis will be used to investigate ways to structurally improve physician quality incentives and use of IT with the goals of higher quality and more cost-effective health care. The second environment that will be investigated is Maine Medical Center, which worked with a technology partner AgileMD to implement mobile technology that aids its 200+ physicians in the treatment of complex medical conditions. In this context, the PI will use a randomized evaluation, together with detailed data on physician behaviors and use of IT, to study the role of mobile technology on productivity. This research program uses cutting edge methods in economics together with novel datasets to investigate key intellectual questions that will enhance our understanding of the economics of an important policy area. In addition to this intellectual merit, the project will have broader impact through both the policies it will impact and the workshop to train a new generation of health economists.