Pricing of Major Cancer Surgeries: Impact of Insurance, Outcomes, and Severity

描述（由申请人提供）：本提案侧重于在医院环境中进行的三种外科手术的定价：结肠切除术（结肠切除术）、肺手术（切除术）和子宫（子宫内膜）子宫切除术及其变体，当与结直肠癌、肺癌和子宫癌的诊断相关时。程序的选择是基于非自由裁量，有限的可能性门诊替代，但有明确的交易价格。感兴趣的主要研究问题是价格的分散，保险对价格的影响，以及汇总到医院水平的结果的作用。我们将确定从按服务收费到严格管理医疗等不同类型的计划在多大程度上能够从医院获得价格折扣。此外，我们将通过医院再入院率、死亡率和与癌症诊断相关的并发症率来衡量，确定更高的价格在多大程度上反映了更好的结果。我们的零假设是，价格的地理分布及其方差很高，管理护理计划获得更大的折扣，医院癌症治疗结果的改善得到市场的奖励。分析将使用私人保险个人索赔的大型数据库进行，其中包含临床信息和实际付款，即交易价格。核心数据将通过MEDPAR的行政数据进行扩充，以估计基于人口的结果，以及其他具有市场水平和县级变量的文件。2002年至2006年的定价数据将汇总在一起，由于价值滞后，以前的年份将用于其他文件。各年的价格将根据医疗通胀进行调整。将采用各种计量经济学和流行病学技术来说明保险计划的选择和实施风险调整的结果。我们将使用一个承认保险和结果都是内生的框架，将医院层面的结果测量和保险选择变量纳入价格方程。我们将为每种类型的手术和价格的两个关键定义中的每一个评估单独的模型：接触（手术）价格和事件（入院）价格。公共卫生相关性：迄今为止，缺乏关于癌症治疗价格分布的信息。除了填补这一空白之外，我们的研究还将告知患者/消费者和第三方支付者在基于潜在护理质量的价格做出选择时的权衡取舍。这一认识也将有助于为日益受到成本上升限制的卫生保健环境的未来政策决策提供信息。

DESCRIPTION (provided by applicant): This proposal focuses on pricing of three surgical procedures performed in hospital settings: colectomy (colon resection), lung surgery (resection) and a uterine (endometrial) hysterectomy and their variants, when associated with the diagnosis of colorectal, lung and uterine cancers. Procedures were chosen on the basis of being non-discretionary, with limited possibility for outpatient substitution, but having well defined transaction prices. The main research questions of interest are the dispersion of prices, the impact of insurance on prices, and the role of outcomes aggregated to the level of the hospital. We will determine the extent to which different types of plans ranging from fee-for-service to strict managed care are able to obtain price discounts from hospitals. Additionally, we will determine the extent to which higher prices reflect better outcomes as measured by hospital rates of readmissions, mortality, and complication rates associated with cancer diagnoses. Our null hypotheses are that geographic dispersion of prices and their variance is high, managed care plans capture greater discounts, and improved cancer outcomes at hospitals are rewarded by markets. The analysis will be performed using a large database of claims for privately insured individuals, containing clinical information and actual payments, i.e., transaction prices. Core data will be augmented by MEDPAR administrative data for estimating population based outcomes, and by other files with market- level and county level variables. Pricing data will be pooled for the years 2002-2006, with prior years used in other files due to lagged values. Prices across years will be adjusted for medical inflation. Various econometric and epidemiological techniques will be employed to account for insurance plan selection and for implementing risk-adjustment in outcomes. We will incorporate hospital-level outcome measures and insurance choice variables into price equations using a framework that recognizes that both insurance and outcomes are endogenous. We will estimate separate models for each type of procedure and for each of the two key definitions of price: contact (surgery) price and episode (admissions) price. PUBLIC HEALTH RELEVANCE: To date there has been a paucity of information on the distribution of prices for cancer care. In addition to filling this gap, our research will inform both patient/consumers and third-party-payers about trade-trade offs in making choices on the basis of price in terms of potential quality of care. This understanding will also help inform future policy decisions in a health care setting that is increasingly constrained by escalating costs.