Collaborative Research: The Influences of Market Power, Mergers, and Provider Incentives on the Cost and Quality of Healthcare: The Case of Dialysis

该奖项资助研究公司之间的竞争如何影响关键医疗保健服务的价格和质量。pi将调查透析行业的变化如何影响公司战略、医疗保险成本和患者预后。该项目将使用一个非常大的数据集来检验从企业竞争的经济理论中得出的假设。这项研究有三个不同的组成部分。第一部分着重于并购如何影响该行业的公司战略以及对患者结果的影响。第二个部分评估影响新设施建设的法规如何影响市场结构以及患者的结果。第三部分分析了医疗保险的支付改革，该改革减少了过度开注射药物的动机，这可能再次影响医疗保险的成本和患者的结果。了解透析服务的市场很重要，原因如下。透析是健康保险费用的重要组成部分；联邦医疗保险每年对透析的报销总额约占整个联邦预算的1%。高质量的透析护理可以改善患者的生活。最后，了解竞争和医疗保险政策的变化如何影响透析市场，将使我们对强有力的竞争、合理的监管和医疗保险报销政策如何能够降低成本和改善患者预后有新的认识。研究小组将使用1998年至2014年间美国透析患者的索赔数据；在此期间，该行业变得更加集中。该奖项资助的项目着眼于透析行业整合的三个不同方面。第一项研究是研究大型透析连锁店如何将他们的公司战略转移到他们收购的众多独立设施上，这最终会影响他们治疗的成本和质量。第二部分发展了透析公司进入、退出和收购决策的结构模型，以(i)了解市场结构和监管如何影响透析护理，（ii）估计反事实政策的影响，如阻止合并或放松需求证明法。第三篇研究了医疗保险的报销政策如何影响透析机构的行为，特别关注2011年的一项改革，该改革将医疗保险的注射药物报销计划从按剂量支付改为捆绑支付。该团队将使用一种新的工具变量策略来提供文献中关于捆绑支付政策是否导致药物剂量降低、成本降低和结果改善的第一个因果证据。该项目推进了市场力量、合并分析和医疗保健提供者激励的经济学文献。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

This award funds research in how competition between firms affects both the price and quality of a key health care service. The PIs will investigate how changes in the dialysis industry affects firm strategies, Medicare costs, and patient outcomes. The project will use a very large data set to test hypothesis drawn from the economic theory of firm competition. The research has three distinct components. The first part focuses on how mergers and acquisitions affect firm strategy in this industry and the consequences for patient outcomes. The second component evaluates how regulations that affect the construction of new facilities influence market structure as well as patient outcomes. The third part analyzes a payment reform instituted by Medicare that reduced the incentives to over-prescribe injectable drugs, which again may have affected both Medicare's costs and patient's outcomes. Understanding the market for dialysis services is important for several reasons. Dialysis is an important component of health insurance costs; Medicare's annual total reimbursements for dialysis amount to about 1% of the entire federal budget. High quality dialysis care improves patients' lives. Finally, understanding how changes in competition and in Medicare policies have affected the dialysis market will give us new knowledge about how robust competition and sensible regulation and Medicare reimbursement policies may be able to reduce costs and improve patient outcomes. The research team will use claims data from the entire universe of U.S. dialysis patients between 1998 and 2014; during this time period the industry became more concentrated. The projects funded by this award look at three different aspects of consolidation in the dialysis industry. The first studies how large dialysis chains have transferred their corporate strategies to the numerous independent facilities they acquired, which ultimately can affect the cost and quality of their treatments. The second develops a structural model of dialysis firms' entry, exit, and acquisition decisions to (i) understand how market structure and regulation affect dialysis care and (ii) estimate the impact of counterfactual policies, such as blocking mergers or relaxing Certificate of Need laws. The third examines how Medicare's reimbursement policies shape dialysis facilities' behavior, focusing specifically on a reform in 2011 that changed Medicare's reimbursement scheme for injectable drugs from a per-dose payment to a bundled payment. The team will use a novel instrumental variable strategy to provide the first causal evidence in the literature about whether the bundled payment policy resulted in lower drug doses, reduced costs and improved outcomes. The project advances the economics literature on market power, merger analysis, and provider incentives in health care.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.