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IMPACT OF MGD CARE ON DEMAND FOR PREVENTIVE & CURATIVE M

MGD 护理对预防性需求的影响

基本信息

批准号：
6538184
负责人：
PRAVIN K TRIVEDI
金额：
$ 14万
依托单位：
TRUSTEES OF INDIANA UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2001
资助国家：
美国
起止时间：
2001-06-08 至 2004-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6538184
关键词：
clinical research disease /disorder prevention /control health care service utilization health economics health services research tag human data managed care

项目摘要

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.

我们提出了一个新的计量经济学研究的影响，管理式医疗保健的预防和治疗利用卫生服务-一个主题，占据了中心位置的研究和政策辩论的设计和改革的公共和私人医疗保健系统。该提案认识到，许多现有的定量和计量经济学研究，调查医疗利用的管理式护理的影响是有缺陷的。首先，大多数实证研究都是基于观察数据，因此遭受由自我选择进入管理式医疗所引起的内分泌偏倚。其次，很少有研究是基于全国代表性的样本。第三，那些不受前两种批评的研究是基于旧的数据，所以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学方法来分析管理式医疗在卫生利用中的作用。我们建议采用1996年的医疗开支专题调查，并以参加某种形式的私人医疗保险的非长者成年人为次样本。我们计划研究两种类型的利用率变量。第一是一套预防保健服务措施。第二套利用率变量是更常用的措施访问不同类型的供应商。管理式医疗的效果是通过两个变量，这是更常用的措施访问不同类型的提供者。管理式医疗的效果是通过两个变量，在HMO和其他类型的管理式医疗计划登记注册。我们的计量经济学模型将涉及两组共同的因变量：一个方程来解释HMO或其他管理式医疗计划的注册，一个方程来解释一些利用率的测量。结果变量是离散随机变量，需要使用非线性模型。在这种情况下发生的内生偏差导致了重大的经济计量复杂性。这些并发症将使用现代计算机密集型方法进行处理。