The Impact of Legal and Regulatory Policy on Patient and Provider Decision Making

凯斯勒9709612这项研究将实证调查法律监管政策和医生决策的影响，以及法律导致的医疗决策变化对医疗成本和患者医疗结果的影响。到目前为止，发表的文献中使用的方法都不是基于数据集，这些数据集允许直接测量假设在法律、医生和患者治疗决定、医疗费用和健康结果之间存在因果关系的所有关键变量。三项研究将解决这个问题。第一个项目评估医疗事故责任法改革对防御性医学的影响。它探讨了医生为什么以及如何从事防御性医学。第二种评估生前遗嘱对临终时的医疗、费用和结果的影响。第三部分评估了医院竞争对医疗服务成本和质量的影响。将使用三种类型的数据。联邦医疗保险A部分和B部分索赔表格和匹配的社会保障死亡日期记录已在分析文件中链接。有关承保服务、出院信息和人口信息的信息也包括在内。此外，正在进行的关于重大疾病的治疗强度和结果的项目数据集指导生前遗嘱分项目。纵向档案跨越1984-1993年，并定期更新。分析将使用100%患有特定疾病的联邦医疗保险受益人的数据，并使用20%的其他受益人的随机样本作为对照组。MedSTAT数据将提供400多万名非老年员工、家属和拥有固定医疗计划的退休人员的索赔记录信息。还将使用国家医院信息数据集。%本研究将实证调查法律监管政策和医生决策的影响，以及法律导致的医疗决策变化对医疗成本和患者医疗结果的影响。到目前为止，发表的文献中使用的方法都不是基于数据集，这些数据集允许直接测量假设在法律、医生和患者治疗决定、医疗费用和健康结果之间存在因果关系的所有关键变量。三项研究将解决这个问题。第一个项目评估医疗事故责任法改革对防御性医学的影响。它探讨了医生为什么以及如何从事防御性医学。第二种评估生前遗嘱对临终时的医疗、费用和结果的影响。第三部分评估了医院竞争对医疗服务成本和质量的影响。将使用三种类型的数据。联邦医疗保险A部分和B部分索赔表格和匹配的社会保障死亡日期记录已在分析文件中链接。有关承保服务、出院信息和人口信息的信息也包括在内。此外，正在进行的关于重大疾病的治疗强度和结果的项目数据集指导生前遗嘱分项目。纵向档案跨越1984-1993年，并定期更新。分析将使用100%患有特定疾病的联邦医疗保险受益人的数据，并使用20%的其他受益人的随机样本作为对照组。MedSTAT数据将提供400多万名非老年员工、家属和拥有固定医疗计划的退休人员的索赔记录信息。还将使用国家医院信息数据集。***

Kessler 9709612 This research will investigate empirically the impact of legal an regulatory policy and physician decision making and the consequences of law-induced changes in health care decision for health care costs and patient health care outcomes. To date, none of the methods used the in the published literature have been based on datasets that would allow direct measurement of all of the key variables hypothesized to have causal relations among the law, physician and patient treatment decisions, health care costs, and health outcomes. Three studies will remedy this problem. The first project estimates the impact of medical malpractice liability law reforms on defensive medicine. It explores the why and how doctors practice defensive medicine. The second estimates the impact of living wills on medical treatment, costs, and outcomes at the end of life. The third estimates the impact of hospital competition on the cost and quality of medical care. Three types of data will be used. Medicare Part A and Part B claims forms and matching Social Security death date records have been linked in analytic files. Information regarding covered services, discharge information, and demographic informant are included. In addition, an ongoing project on Treatment Intensity and Outcomes of major illness data set guides the living will subproject. The longitudinal files span 1984-1993 and are updated regularly. The analyses will use data from 100 percent of Medicare beneficiaries who have ever had a particular illness will use 20% random sample of other beneficiaries as a comparison group. Medstat data will provide information on claims records for over 4 million nonelderly employees, dependents, and retirees with firm medical plans. National hospital information datasets will be used as well. %%% This research will investigate empirically the impact of legal an regulatory policy and physician decision making and the consequences of law-induced changes in health care decision for health care costs and patient health care outcomes. To date, none of the methods used the in the published literature have been based on datasets that would allow direct measurement of all of the key variables hypothesized to have causal relations among the law, physician and patient treatment decisions, health care costs, and health outcomes. Three studies will remedy this problem. The first project estimates the impact of medical malpractice liability law reforms on defensive medicine. It explores the why and how doctors practice defensive medicine. The second estimates the impact of living wills on medical treatment, costs, and outcomes at the end of life. The third estimates the impact of hospital competition on the cost and quality of medical care. Three types of data will be used. Medicare Part A and Part B claims forms and matching Social Security death date records have been linked in analytic files. Information regarding covered services, discharge information, and demographic informant are included. In addition, an ongoing project on Treatment Intensity and Outcomes of major illness data set guides the living will subproject. The longitudinal files span 1984-1993 and are updated regularly. The analyses will use data from 100 percent of Medicare beneficiaries who have ever had a particular illness will use 20% random sample of other beneficiaries as a comparison group. Medstat data will provide information on claims records for over 4 million nonelderly employees, dependents, and retirees with firm medical plans. National hospital information datasets will be used as well. ***