Causes and Consequences of Health Care Intensity

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DESCRIPTION (provided by applicant): Socioeconomic status and race are clearly associated with large differences in treatments and outcomes for many health problems, and there is evidence that such disparities are increasing over time. But relatively little is known about the causes of such variations. Are they the consequence of patient preferences or physician behavior? Nor is the role of geography in disparities well understood: do African-Americans, for example, receive less care because they happen to live in regions with lower overall utilization rates? This resubmission of Project 4 will provide new evidence on these issues by examining the relationships among variations in provider, area, and policy factors, treatments and health outcomes. We will Examine the relationship of physician, hospital and regional characteristics to differences in treatments and outcomes. Oaxaca-Blinder decompositions will be used to estimate how treatment patterns, as well as outcome differences, are associated with race and income. Estimate to what extent differences in treatments reflect the patient preferences. Using the proposed Survey of Patient Preferences (Core C Supplement), preferences for scale, scope, and surveillance intensity will be compared by age, sex and race of respondent. Measure factors that explain Black-White and income differences in access to high quality health care. Using the Medicare claims data and the Medicare Current Beneficiary Survey, we will address whether African-American or low income elderly patients are admitted to lower quality hospitals and, if so, why. Consider the role of technological innovation on the rising disparities in health outcomes following hospital admissions for heart attacks (AMI). Variations in the diffusion of surgical innovations across race and region will be used to estimate the role of technology in the rising inequality in health outcomes. Determine the effects of policy changes on treatment and health disparities in the elderly population by focusing on two important areas where there have been significant changes: (a) Medicaid eligibility and (b) the Disproportionate Share Hospital (DSH) program, both of which increased reimbursements to hospitals serving large disadvantaged populations.