IMPACT OF MGD CARE ON DEMAND FOR PREVENTIVE & CURATIVE M

MGD 护理对预防性需求的影响

• 批准号: 6370704
• 负责人: PRAVIN K TRIVEDI
• 金额: $ 14.35万
• 依托单位: TRUSTEES OF INDIANA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-06-08 至 2003-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6370704
• 关键词: clinical research; disease /disorder prevention /control; health care service utilization; health economics; health services research tag; human data; managed care

We propose a new econometric study of the effects of managed care on preventive and curative utilization of health services - - a topic which occupies a central place in research and policy debates regarding the design and reform of public and private health care systems. The proposal recognizes that many existing quantitative and econometric studies that investigate the impact of managed care of medical utilization are flawed. First, most empirical studies are based on observational data and hence suffer from endogeneity bias caused by self- selection into managed care. Second, few of the studies are based on nationally representative samples. Third, those studies that are not subject to the two preceding criticisms are based on old data, so their conclusions may not generalize to the present. This proposal puts forward new econometric methodology for analyzing the role of managed care in health utilization. We propose to use the 1996 Medical Expenditure Panel Survey and focus on the sub-sample of non-elderly adults who have some form of private health insurance. We plan to examine two types of utilization variables. The first is a set of measures of preventive care services. The second set of utilization variables are more commonly used measures of visits to different types of providers. The effect of managed care is captured via two variables, which are more commonly used measures of visits to different types of providers. The effect of managed care is captured via two variables, enrollment in an HMO and enrollment in other types of Managed Care plans. Our econometric models will involve two sets of jointly dependent variables: an equation to explain enrollment in HMO or other managed care plan, and an equation to explain some measure of utilization. The outcome variables are discrete random variables that require use of nonlinear models. The occurrence of endogeneity bias in this context leads to significant econometric complications. These complications will be handled using modern computer-intensive methods.

我们提出了一项新的计量经济学研究，研究管理式医疗对卫生服务预防和治疗利用的影响--这一主题在有关公共和私营卫生保健系统的设计和改革的研究和政策辩论中占据中心位置。该提案承认，现有的许多调查管理性医疗对医疗利用的影响的定量和计量经济学研究是有缺陷的。首先，大多数经验性研究是基于观察数据，因此受到自我选择进入管理型医疗所造成的内生性偏差。其次，很少有研究是基于具有全国代表性的样本。第三，那些不受前两种批评影响的研究是基于旧数据的，因此他们的结论可能不会推广到现在。这一建议提出了新的计量经济方法，用于分析管理型医疗在卫生利用中的作用。我们建议使用1996年的医疗开支小组调查，并集中在拥有某种形式的私人健康保险的非老年成年人的分组样本。我们计划检查两种类型的利用率变量。首先是一套预防性护理服务的措施。第二组利用率变量是更常用的访问不同类型提供商的度量。管理式护理的效果通过两个变量来获取，这两个变量是对不同类型提供者的访问的更常用的衡量标准。管理性医疗的影响通过两个变量来捕捉，即参加HMO和参加其他类型的管理性医疗计划。我们的计量经济学模型将涉及两组联合因变量：一个方程解释HMO或其他管理性医疗计划的登记人数，另一个方程解释利用率的某些衡量标准。结果变量是离散的随机变量，需要使用非线性模型。在这一背景下，内生性偏差的出现导致了重大的计量经济学并发症。这些复杂情况将使用现代计算机密集型方法来处理。