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

描述（由申请人提供）：美国高水平医疗保健支出和利用率的价值经常受到质疑。达特茅斯地图集项目研究人员利用医疗保险索赔数据，发现总体支出以及可自由支配和昂贵服务的使用存在显着的地理差异，尽管支出较高地区的患者寿命并没有更长，或者对所接受的护理的总体满意度更高。虽然更密集的医疗保健利用可能不会延长患者的生命，但额外的治疗可能会对患者福祉的多个维度产生重要且目前未被认识到的后果，包括功能状态和生产性参与（例如，有偿工作、志愿服务以及为家庭成员提供无偿护理）。本研究评估了治疗四种常见慢性病（关节炎、背痛、白内障和心脏病）的择期手术对与生活质量（包括行动能力和抑郁）相关的健康和残疾结果以及包括有偿和无偿工作在内的经济结果的影响。来自健康与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，将有助于通过比较一段时间内接受者与非接受者的双重差异方法来估计手术的因果效应。实践模式的地理差异将允许对不同疾病严重程度接受手术的患者进行比较。 这项研究的结果将有助于医疗保险和医疗补助服务中心以及其他付款人制定基于证据的政策，并为不断发展的成本效益研究领域做出及时的方法论贡献。患者、他们的家人和雇主将成为这些发现的最终受益者，因为提供者和付款人可以解释医疗保健干预措施在维护通常无法衡量的健康和生产参与方面的有效性。这项研究将为政策制定者提供重要信息，以实施《平价医疗法案》并考虑进一步修改医疗保险计划，以应对不断上升的医疗成本和 65 岁以上人口的快速增长。除了科学目标之外，该职业发展奖还将为受过博士学位的健康经济学家提供老年学、医学和公共卫生方面的培训。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领域进行前沿研究，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.