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

医疗保健成本增长是美国目前面临的核心政策问题之一：美国国内生产总值的17.4%用于医疗保健支出，而所有医疗支出的43%来自联邦、州和地方政府。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，可以在不对健康产生负面影响的情况下减少支出。2010年的《平价医疗法案》（Affordable Care Act）大大增加了获得医疗保健的机会，但几乎没有包括应对成本增长挑战的条款。促进有效医疗保健支出的现行政策方法包括：（一）消费者费用分摊；（二）卫生技术评估；（三）医生支付改革；（四）改进信息技术的使用。该项目旨在促进我们对如何以具有成本效益的方式改善人口健康的理解。它侧重于更好地理解（一）医生如何应对提供高质量医疗保健的财政激励，以及（二）医生的治疗如何应对先进It工具的可用性。尽管了解这些医疗服务提供者的行为很重要，但对这些主题的研究有限。该项目利用独特的数据，并采用尖端的经济学方法来推进我们对这些领域的医生和患者行为的科学理解。这些研究进展应对寻求以具有成本效益的方式改善国民健康和福祉的政策产生直接影响。除了这一研究层面，该项目还将为卫生经济学研究生设立一个讲习班，旨在促进对科学技术的全面理解，以便在原创性研究中在这一领域取得进展。本次研讨会将汇集来自全国各地的主要卫生经济学家，培训卫生经济学和卫生政策方面的博士生。拟议的和拟议的讲习班将产生更广泛的影响，而不仅仅是科学进步，包括卫生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，这些数据集可以详细跟踪医生行为和患者行为。第一个被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，在2012年，HMSA领导了一个复杂的IT工具的全系统实施，该工具为医生提供有关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70万名患者的患者行为和特征，（ii）超过1000名医生的医生行为和特征。关键的微观层面的信息被准确地观察到医生如何回应质量激励和使用可用的信息技术，在hsa实施特定的关键变化之前和之后。PI将利用这些微观层面的数据来调查与医生培训、医生治疗的患者概况和医生组织特征相关的异质性影响。该分析将用于调查如何从结构上改善医生质量激励和信息技术的使用，以实现更高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合作实施移动技术，帮助其200多名医生治疗复杂的医疗状况。在此背景下，PI将使用随机评估，结合医生行为和信息技术使用的详细数据，来研究移动技术对生产力的作用。这个研究项目使用经济学的前沿方法和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一个重要政策领域的经济学的理解。除了这一知识价值之外，该项目还将通过它将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.