Relative Price, Payer Mix and Regional Variations in Medical Care

医疗保健的相对价格、付款人组合和地区差异

• 批准号: 8704157
• 负责人: Jonathan David Ketcham
• 金额: $ 20.86万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8704157
• 关键词: Relative; Price; Payer; Mix; Regional

DESCRIPTION (provided by applicant): Medicare utilization and spending vary substantially across regions of the US (Fisher 2003a, 2003b), and the additional spending in high-cost areas has little known value (Fisher et al., 2009). Far less is known about the causes of such variations. Two related, prevailing hypotheses are that local norms create a region's "signature style", and those high spending results from too many hospitals and physicians. Under these hypotheses, Medicare and private spending are predicted to have a high degree of similarity within a given region. Under these hypotheses, the higher levels of spending represent pure waste in Medicare and in the US health care system as a whole. A number of policies are justified by these hypotheses, including restricting the number of doctors and hospitals and reducing Medicare reimbursement levels in high spending areas. In this study we propose and test a different theoretical explanation of Medicare's regional variations. We accomplish this by using a rich, newly-available dataset in conjunction with other data to test a widely- familiar economic theory of provider behavior. Specifically, we will use data from FAIR Health, Thomson Reuters MarketScan, and Medicare Part B to test whether geographic variations in Medicare spending for physicians can be explained by the profitability of Medicare relative to other payers. We develop this hypothesis based on the economic model of stepwise demand. The central insight from this model relevant to Medicare variations is straightforward: Medicare's profitability relative to other payers affects Medicare utilization and spending. This occurs because providers respond to Medicare's profitability by altering their payer mix. Providers accomplish this by altering the prices they charge to privately-insured patients. Contrary to cost shifting, this yields the hypothesis that reductions in Medicare fee changes would be met with reductions in prices for privately-insured patients. Also contrary to cost offsets, this hypothesizs that reductions in Medicare reimbursement would lead to lower, not higher, Medicare utilization. This project will achieve three specific aims. In Specific Aim 1, we will test for cost shifting. Or preliminary studies contradict the cost-shifting hypothesis and support the hypothesis from the stepwise demand model. This heightens the need to complete Specific Aims 2 and 3. In Specific Aim 2 we will test for cost offsets. In Specific Aim 3 we examine whether and to what extent the regional variations in Medicare spending and utilization are due to physicians altering their payer mix in response to Medicare's profitability relative to privately-insured patients. This will establish what percent of the regional variation in Medicare spending is due to differences in the profitability of Medicare relative to privately-insured patients. The broad, long term objective o this study is to guide researchers and policy makers' understanding of physicians' responses to changes in Medicare reimbursement and the source of Medicare variations. These results will inform which policies, if any, should be implemented to reduce these variations.

描述（由申请人提供）：美国各地区的医疗保险利用率和支出差异很大（Fisher 2003 a，2003 b），高成本地区的额外支出几乎没有已知的价值（Fisher等人，2009年）。人们对这种变化的原因知之甚少。两个相关的流行假设是，地方规范创造了一个地区的“标志性风格”，而这些高支出是由于太多的医院和医生。在这些假设下，预计医疗保险和私人支出在给定区域内具有高度相似性。在这些假设下，更高水平的支出代表着医疗保险和整个美国医疗保健系统的纯粹浪费。这些假设证明了一些政策的合理性，包括限制医生和医院的数量，以及降低高支出地区的医疗保险报销水平。 在这项研究中，我们提出并测试了不同的理论解释医疗保险的区域差异。我们通过使用一个丰富的，新的数据集与其他数据相结合，以测试一个广泛熟悉的经济理论的供应商行为来实现这一点。具体来说，我们将使用来自FAIR Health、汤姆森路透社MarketScan和医疗保险Part B的数据来测试医疗保险支出的地理差异是否可以用医疗保险相对于其他支付者的盈利能力来解释。我们发展了这个假设的基础上逐步需求的经济模型。从这个模型中得出的与医疗保险变化相关的核心观点是直截了当的：医疗保险相对于其他支付者的盈利能力影响医疗保险的利用和支出。发生这种情况是因为供应商通过改变他们的支付者组合来应对医疗保险的盈利能力。提供者通过改变他们向私人保险患者收取的价格来实现这一点。与成本转移相反，这产生了一个假设，即医疗保险费用变化的减少将与私人保险患者价格的降低相一致。同样与成本抵消相反，这一假设是，医疗保险报销的减少将导致医疗保险利用率降低，而不是提高。 该项目将实现三个具体目标。在具体目标1中，我们将测试成本转移。或者，初步研究与成本转移假说相矛盾，并支持逐步需求模型的假说。这就更加需要完成具体目标2和3。在具体目标2中，我们将测试成本抵消。在具体目标3中，我们研究了医疗保险支出和利用率的区域差异是否以及在多大程度上是由于医生改变了他们的支付者组合，以应对医疗保险相对于私人保险患者的盈利能力。这将 确定医疗保险支出的区域差异的百分比是由于医疗保险相对于私人保险患者的盈利能力差异。 本研究的广泛、长期目标是指导研究人员和政策制定者了解医生对医疗保险报销变化的反应以及医疗保险变化的来源。这些结果将告知应该实施哪些政策（如果有的话）来减少这些变化。