Costs and Quality of Primary Care Services: Implications for Community Health Centers

项目概要/摘要 社区卫生中心（CHC）通过提供服务在美国医疗保健系统中发挥着重要作用 为1300多个国家约2600万医疗服务不足的人口提供初级保健 不管病人的支付能力如何。鉴于这一使命，CHC在历史上一直暴露于 相对较高的金融风险。通过设立一个信托基金，联邦对社区卫生中心的供资大幅增加 根据《平价医疗法案》，信托基金目前计划于2019年结束。金融 随着国会考虑大幅减少对社区卫生服务的资助，社区卫生服务的前景受到进一步威胁。 医疗补助扩张和市场补贴。 社区卫生中心的可行性取决于可持续的财务健康。迄今为止，ACA对CHC影响的研究 财务业绩侧重于收入来源变化的影响。然而，财务利润率是 包括收入和成本两部分。该项目的独特之处在于采用供应方方法， 基于企业微观经济理论，通过估算经济成本函数来评估社区卫生服务绩效。在 成本函数分析主要用于医院和疗养院的分析 文学。我们的项目是第一个将这些方法应用于CHCs的研究。 我们建议采用一个独特的和未充分利用的面板数据库，以探讨CHC成本，并确定 社区卫生服务成本效益的驱动因素，因为它们与社区卫生服务目前面临的政策挑战有关。我们最初将提供 详细说明国家一级社区卫生服务费用各组成部分的差异， 对政策有意义的分组的估计，如医疗补助扩张与非扩张状态和高 与低医疗短缺地区相比，以及2011-2018年研究期间的趋势。接下来，我们将创建key CHC特有的变量，这些变量将用作CHC成本函数估计的构建块。这些包括 工资指数（劳动力投入价格）、资本成本指标、设施组合指数和综合质量 成绩.使用这些措施，我们将估计多产品的translog成本函数在我们的主要经验 规范，并在敏感性分析中估计半对数模型。我们将应用我们的成本结果 功能估计，以产生一套结构，在解决政策相关的问题有用。一是 评估社区卫生服务中心是否因服务扩展而节省了成本。第二，我们将 检查整合初级保健访问等的潜在成本节约和互补性 中心的专业服务，特别是心理健康。第三，由于资金限制可能影响护理质量， 我们将探讨社区卫生服务成本和护理质量之间的潜在权衡。

Project Summary/Abstract Community health centers (CHCs) play an essential role in the U.S. health care system by delivering primary care to a medically underserved population of approximately 26 million individuals in more than 1,300 CHCs regardless of patients' ability to pay. Given this mission, CHCs historically have been exposed to relatively high financial risk. Federal funding for CHCs increased substantially through a trust fund established under the Affordable Care Act; however, trust funding currently is scheduled to end in 2019. The financial outlook for CHCs is threatened further as Congress considers options to significantly reduce funding for Medicaid expansion and Marketplace subsidies. CHC viability depends upon sustainable financial health. To date, studies of the ACA impact on CHC financial performance have focused on the effects of changing sources of revenue. Yet financial margins are comprised of both revenue and cost components. This project is unique in taking a supply side approach to CHC performance by estimating economic cost functions premised on the microeconomic theory of the firm. In health care, cost function analyses have been used primarily in analyses in the hospital and nursing home literatures. Our project is the first study to apply these methods to CHCs. We propose to employ a unique and underutilized panel database to explore CHC costs and to identify drivers of CHC cost efficiency as they relate to current policy challenges facing CHCs. We initially will provide a detailed description of national level variation in various components of CHC costs, establishing baseline estimates for policy-meaningful groupings such as Medicaid-expansion versus non-expansion states and high versus low medical shortage areas, and trends in the 2011-2018 study period. Next we will construct key variables unique to CHCs that will serve as building blocks for CHC cost function estimation. These include a wage index (labor input price), a cost of capital measure, a facility case-mix index, and composite quality scores. Using these measures, we will estimate multi-product translog cost functions in our main empirical specification, and estimate semi-log models in sensitivity analyses. We will apply the results of our cost function estimations to produce a set of constructs useful in addressing policy-relevant issues. First, we will assess whether CHCs experience cost-savings from service expansion versus contraction. Second we will examine potential cost savings and complementarities from integrating primary care visits and more specialized services in centers, notably mental health. Third, as funding constraints may affect quality of care, we will explore the potential trade-off between CHC costs and quality of care.