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

描述(由申请人提供)：美国高水平的医疗支出和利用的价值经常受到质疑。使用联邦医疗保险索赔数据，达特茅斯项目的研究人员发现，总体支出和非必需和昂贵服务的使用存在显著的地理差异，尽管支出较高地区的患者没有活得更长，也没有报告对所接受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，但对患者幸福感的多个维度进行额外治疗可能会产生重要的、目前尚未被认识到的后果，包括功能状态和生产性参与(例如，为报酬工作、志愿服务和向家庭成员提供无偿护理)。这项研究评估了用于治疗四种常见慢性病(关节炎、背痛、白内障和心脏病)的择期手术对健康和残疾结果的影响，这些结果与生活质量有关，包括行动不便和抑郁，以及包括有偿和无偿工作在内的经济结果。来自健康和退休研究的与受访者的联邦医疗保险索赔和全国联邦医疗保险数据有关的纵向调查数据将促进差异中的方法，通过比较一段时间内接受者和非接受者，来评估手术的因果影响。实践模式的地理差异将允许比较不同疾病严重程度的患者接受手术的情况。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基于证据的决策，并为不断增长的成本效益研究领域做出及时的方法学贡献。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说明医疗干预措施在保留通常无法衡量的健康和生产性参与方面的有效性。这项研究将为政策制定者实施平价医疗法案并考虑进一步改革医疗保险计划，以应对不断上涨的医疗成本和65岁以上人口的快速增长提供重要信息。除了科学目标，这个职业发展奖还将为受过博士培训的卫生经济学家提供老年学、医学和公共卫生方面的培训。在培训期间获得的技能将使应聘者能够在经济学、医学和老年学的交叉点进行前沿研究，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.