Geographic Variation in the Health and Economic Determinants and Outcomes of Elec

描述（由申请人提供）：在美国，高水平的医疗保健支出和利用率的价值经常受到质疑。利用医疗保险索赔数据，达特茅斯阿特拉斯项目的研究人员发现，尽管高支出地区的患者寿命不长，或对所接受的护理总体满意度不高，但总体支出和可自由支配和昂贵服务的使用存在显著的地理差异。虽然更密集的医疗保健利用可能不会延长患者的生命，但对于患者健康的多个维度，包括功能状态和生产性参与（例如，为报酬工作、志愿服务和为家庭成员提供无偿护理）。这项研究评估了选择性手术治疗四种常见慢性疾病（关节炎，背痛，白内障和心脏病）对健康和残疾结果的影响，这些结果与生活质量有关，包括流动性和抑郁症，以及经济结果，包括有偿和无偿工作。来自健康和退休研究的纵向调查数据与受访者的医疗保险索赔和国家医疗保险数据相关联，将有助于通过随时间推移比较接受者与非接受者来估计手术的因果影响的差异方法。实践模式的地理差异将允许在不同疾病严重程度下对接受手术的患者进行比较。 这项研究的结果将促进医疗保险和医疗补助服务中心和其他付款人的循证决策，并及时为不断增长的成本效益研究领域做出方法上的贡献。患者，他们的家人和雇主将是这些发现的最终受益者，因为提供者和支付者可以解释医疗保健干预措施在保护健康和生产性参与的典型不可测量方面的有效性。这项研究将为实施《平价医疗法案》的政策制定者提供重要信息，并考虑对医疗保险计划进行进一步改革，以解决医疗成本上升和65岁以上人口快速增长的问题。除了科学目标，这个职业发展奖将提供老年学，医学和公共卫生博士培训的卫生经济学家的培训。在培训期间获得的技能将使候选人能够在经济学，医学和老年学的交叉点进行尖端研究，为老年人的健康政策提供信息。

DESCRIPTION (provided by applicant): The value of high levels of healthcare spending and utilization in the United States is frequently questioned. Using Medicare claims data, Dartmouth Atlas Project researchers identify significant geographic variation in overall spending and use of discretionary and expensive services though patients in higher spending regions do not live longer or report greater overall satisfaction with care received. While more intensive healthcare utilization may not extend patients' lives, there may be important and currently unappreciated consequences of additional treatments for multiple dimensions of patient well-being, including functional status and productive engagement (e.g., working for pay, volunteering, and providing unpaid care to family members). This study assesses the effect of elective surgery to treat four common chronic conditions (arthritis, back pain, cataracts and heart disease) on health and disability outcomes related to quality of life including mobility and depression, and economic outcomes including paid and unpaid work. Longitudinal survey data from the Health and Retirement Study linked to respondents' Medicare claims and national Medicare data will facilitate a difference-in-differences approach to estimating a causal effect of surgery by comparing recipients to non-recipients over time. Geographic variation in practice patterns will allow comparisons of patients receiving surgery at different levels of disease severity. The results of this study will facilitate evidence-based policymaking by the Centers for Medicare and Medicaid Services and other payers, and make timely methodological contributions to the growing field of cost- effectiveness research. Patients, their families, and employers will be the ultimate beneficiaries of these findings as providers and payers can account for the effectiveness of healthcare interventions in preserving typically unmeasured aspects of health and productive engagement. This research will provide important information to policymakers implementing the Affordable Care Act and considering further changes to the Medicare program to address rising healthcare costs and the rapid growth of the over-65 population. Beyond the scientific aims, this career development award will provide training in gerontology, medicine, and public health for a PhD-trained health economist. The skills obtained during the training period will enable the candidate to perform cutting-edge research at the intersection of economics, medicine, and gerontology to inform health policies towards older adults.