ROLE OF TECHNOLOGY IN HEALTH CARE COST GROWTH

技术在医疗保健成本增长中的作用

• 批准号: 6785000
• 负责人: MICHAEL E CHERNEW
• 金额: $ 10万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6785000
• 关键词: behavioral /social science research tag; clinical research; disease /disorder; health care cost /financing; health economics; health insurance; human data; human subject; interview; physicians; technology /technique

DESCRIPTION (PROVIDED BY APPLICANT): Most health economists (81 percent) believe that the primary explanation for rising health care expenditures is the increasing development, adoption, and utilization of new medical technology. This study aims to extend our understanding of the role of technology in driving cost growth. We have three objectives: 1. To assess which diseases have contributed most to health care cost growth at the population level. 2. To assess the role of technology in contributing to cost growth 3. To assess the types of technology that have influenced cost growth since 1996 and the types of patients to which they have been applied. Two research methods will be used to accomplish these aims. First, retrospective analysis of a large administrative claims database will be conducted to identify which diseases have contributed most to cost growth. This analysis will follow the residual method for identifying the role of technology in driving cost growth. Specifically, like the literature, we will adjust for changing demographics. In contrast to much of the existing literature, we will be able to control, in a much more detailed way, for changing prices and insurance design as well as for geographic population shifts which might be important given the cross-sectional variation in health care spending. Following the literature, the residual cost growth will be attributed to "technology." Because much of what is labeled as technology in the residual method may not in fact be technology, we will conduct a series of semistructured interviews with physicians to better understand how and why practice patterns have changed. This will enable us to get a more detailed sense of the role of technology in determining cost growth and allow us to address specific aims 2 and 3. In contrast to much of the work in this area, we will focus on a commercially insured population, allowing us to comment on cost increases that relate to premium increases in the employer market. Also in contrast to much of the existing literature, we will be able to separate out changes in incidence from changes in resource use conditional on disease incidence. Both incidence and conditional resource use may be affected by technology. The semistructured interviews will be designed to provide some understanding of how technology has affected both of these components of cost growth, relative to other unobserved factors such as rising obesity rates.

大多数健康经济学家（81%）认为，医疗保健支出增加的主要原因是新医疗技术的不断发展、采用和利用。 这项研究旨在扩大我们对技术在推动成本增长中的作用的理解。 我们有三个目标： 1. 评估在人口水平上，哪些疾病对卫生保健费用增长的贡献最大。 2. 评估技术在促成成本增长方面的作用 3. 评估自1996年以来影响成本增长的技术类型及其应用于的患者类型。 两种研究方法将用于实现这些目标。 首先，将对大型行政索赔数据库进行回顾性分析，以确定哪些疾病对费用增长贡献最大。 这一分析将遵循余值法，以确定技术在推动成本增长方面的作用。 具体来说，就像文献一样，我们将根据不断变化的人口统计数据进行调整。 与现有文献相比，我们将能够以更详细的方式控制价格和保险设计的变化以及地理人口的变化，这可能是重要的，因为医疗保健支出的横截面变化。 根据文献，剩余成本的增长将归因于“技术”。“因为在剩余法中被标记为技术的大部分内容实际上可能不是技术，我们将对医生进行一系列半结构化访谈，以更好地了解实践模式如何以及为什么发生了变化。 这将使我们能够更详细地了解技术在决定成本增长方面的作用，并使我们能够解决具体目标2和3。 与这一领域的大部分工作相反，我们将重点关注商业保险人口，使我们能够评论与雇主市场保费增加有关的成本增加。 与现有的文献相比，我们将能够将发病率的变化与疾病发病率条件下资源使用的变化分开。 发生率和有条件的资源使用都可能受到技术的影响。半结构化访谈的目的是提供一些了解技术如何影响成本增长的这两个组成部分，相对于其他未观察到的因素，如肥胖率上升。