The United States Complementary and Alternative Medicine Market

描述(由申请人提供)：近期和长期的职业目标。候选人的最终长期职业目标是成为一名独立的卫生服务研究员，专门从事补充和替代医学(CAM)。候选人在获奖期间的直接职业目标包括：(1)管理和操作国家医疗保健数据集所需的高级技能，(2)定量研究方面的额外教育和培训，(3)市场研究理论基础，以及(4)研究患者决策过程所需的技能。近期职业目标的实现将通过以下活动来促进：(1)达特茅斯卫生政策和临床实践研究所(TDI)和达特茅斯学院塔克商学院的授课工作，(2)有指导的二级数据分析，以及(3)在指导下发展赠款撰写和手稿准备技能。研究项目：候选人的研究项目将需要使用医疗支出小组调查(MEPS)进行二次数据分析。MEP由卫生研究和政策机构每年进行，是卫生服务利用和支出的最大数据来源之一，其中包括CAM从业者提供的服务。该研究项目是对以美国从业者为基础的CAM服务的严格市场份额分析，将检查CAM使用和支出的纵向趋势。该研究项目的具体目标是：(1)确定2001-2007年间美国成年人以从业者为基础的CAM服务在全国所有卫生服务支出中的市场份额如何变化，以及这些变化是否可归因于患者数量、单位成本、患者社会人口学和/或患者健康状况的变化；(2)对2001-2007年加州、纽约州、德克萨斯州、佛罗里达州、伊利诺伊州、宾夕法尼亚州和俄亥俄州的脊椎按摩服务进行州级供需分析，以确定CAM服务使用率是否存在地域差异，这些差异不是由患者社会人口统计、患者健康状况或单位成本的差异解释的，而是与地区脊椎按摩师的供应相关；以及(3)检查2007-2011年的趋势，以确定CAM使用率的变化速度是否与2008-2009年经济低迷期间的医疗服务使用率不同。 公共卫生相关性：这项研究项目将第一次检查以从业者为基础的CAM服务的市场份额随时间的变化。我们亦会研究客户服务的使用率是否存在地区差异，以及该等差异是否与客户服务供应的差异有关，以及在经济衰退的情况下，客户服务是扮演“正常货品”的角色，还是更像医疗服务(这些服务对经济衰退的影响相当大)。这些发现对于决策者来说将是重要的，他们需要了解新的CAM服务引入医疗市场的影响，考虑和预测不断扩大的CAM劳动力对市场内卫生服务利用的影响，以及预测经济低迷对CAM利用的影响。

DESCRIPTION (provided by applicant): Immediate and long-term career goals. The candidate's ultimate long-term career goal is to become an independent health services researcher specializing in complementary and alternative medicine (CAM). The candidate's immediate career goals during the award period include the acquisition of: (1) advanced skills required to manage and manipulate national healthcare datasets, (2) additional education and training in quantitative research, (3) a foundation in marketing research theory, and (4) the skills necessary to study patient decision-making processes. Achievement of the immediate career goals will be facilitated by the following activities: (1) didactic coursework at The Dartmouth Institute for Health Policy and Clinical Practice (TDI) and the Tuck School of Business at Dartmouth College, (2) mentored secondary data analyses, and (3) mentored development of grant-writing and manuscript preparation skills. Research project: The candidate's research project will entail secondary data analyses using the Medical Expenditure Panel Survey (MEPS). The MEPS is conducted annually by The Agency for Health Research and Policy and is one of the largest sources of data on health services utilization and expenditures that includes services provided by CAM practitioners. The research project is a rigorous market share analysis of US practitioner-based CAM services that will examine longitudinal trends in CAM utilization and expenditures. The Specific Aims of the research project are to: (1) Determine how the market share of practitioner-based CAM services by US adults as a proportion of the national expenditures on all health services has changed between 2001-2007, and whether those changes were attributable to changes in patient volumes, unit costs, patient sociodemographics, and/or patient health status; (2) Perform a state-level supply and demand analysis of chiropractic services for California, New York, Texas, Florida, Illinois, Pennsylvania, and Ohio for 2001-2007 to determine whether there are geographic variations in CAM services utilization that are NOT explained by differences in patient sociodemographics, patient health status, or unit costs, but are correlated with the regional supply of chiropractors; and (3) Examine trends from 2007-2011 to determine whether CAM utilization changed at a different rate than did medical services utilization during the 2008-2009 economic downturn. PUBLIC HEALTH RELEVANCE: This research project will be the first to examine changes in the market share of practitioner-based CAM services over time. We will also determine whether there are regional variations in utilization of CAM services and whether such variations are associated with differences in the supply of CAM services, and whether, in recessionary conditions, CAM services act as "normal goods" or act more like medical services (which are fairly recession-proof). These findings will be important to policymakers who need to understand the effect of the introduction of new CAM services into the healthcare market, to consider and anticipate the effect of an expanding CAM workforce on health services utilization within a market, and to anticipate the effect of economic downturns on CAM utilization.