Designing policies to incentivize high-quality health care for vulnerable Americans: Evidence from the 340B Drug Pricing Program

项目总结/摘要 博士Sunita Desai的长期目标是制定政策，支持和激励供应商投资于高 为弱势群体提供优质护理和服务。 这项提案是实现德赛博士长期目标的第一步，它将研究这样一个项目的影响。 政策，340 B药品定价计划，该计划将财政资源导向符合条件的医院及其 门诊实践服务不成比例的低收入人群。拟议的研究将 产生新的证据，证明该计划是否达到了提高临床质量的预期目标 对脆弱患者和/或对药物供应造成意外溢出效应 和私人保险的支出。 博士德赛是纽约大学医学院人口健康系的助理教授。她 拥有宾夕法尼亚大学沃顿商学院医疗保健管理和经济学博士学位。 他曾是哈佛卫生保健政策系的塞德曼研究员 医学院她接受过医疗保健经济学、准实验研究方法和 使用大型管理数据集进行辅助数据分析。德赛博士试图补充她的背景 在医疗保健经济学和定量方法与临床质量和药物结果的培训 计量、弱势群体未得到满足的保健需求和定性方法。本次培训 将给予德赛博士研究临床细微差别和人群特异性措施的技能， 定性的方法来通知定量调查。 本提案的目的是（1）评估340 B计划参与对医院质量的影响， 护理无保险和医疗补助的患者，（2）评估医院340 B参与对药物治疗的影响 低收入和私人保险人群的使用和坚持，（3）确定障碍， 促进医院有效参与340 B计划，与政策目标一致。 这一建议明确指出了AHRQ对激励措施在卫生保健系统中的作用的重视 绩效（NOT-HS-14-005），重点关注AHRQ优先人群，包括低收入和无保险人群 患者它将产生新的和政策相关的证据，340 B计划对病人护理的影响 在所有主要的支付群体和没有保险的人群中。结果还将为安全网医疗保健提供见解 更广泛的政策。该奖项将支持德赛博士向独立的过渡， 研究议程，为促进可靠和高质量的医疗保健系统的政策提供信息， 脆弱的美国人

PROJECT SUMMARY/ABSTRACT Dr. Sunita Desai’s long-term goal is to inform policies that support and incentivize providers to invest in high- quality care and access for vulnerable populations. This proposal, which is the first step in achieving Dr. Desai’s long-term goal, will study the impacts of one such policy, the 340B Drug Pricing Program, which directs financial resources to eligible hospitals and their outpatient practices serving disproportionate shares of low-income populations. The proposed research will generate novel evidence on whether the Program has achieved its intended goals of improving clinical quality and drug outcomes for vulnerable patients and/or has caused unintended spillover effects on drug provision and spending to the privately insured. Dr. Desai is an assistant professor in the Department of Population Health at NYU School of Medicine. She has a PhD in Health Care Management and Economics from The Wharton School of the University of Pennsylvania and was previously a Seidman Fellow in the Department of Health Care Policy at Harvard Medical School. She is trained in health care economics, quasi-experimental research methods, and secondary data analysis using large administrative datasets. Dr. Desai seeks to complement her background in health care economics and quantitative methods with training in clinical quality and drug outcomes measurement, the unmet health care needs of vulnerable populations, and qualitative methods. This training will give Dr. Desai the skills to study clinically-nuanced and population-specific measures and to leverage qualitative methods to inform quantitative inquiry. The aims of this proposal are (1) to estimate the impact of 340B Program participation on hospital quality of care for uninsured and Medicaid patients, (2) to assess the impact of hospital 340B participation on medication use and adherence among low-income and privately insured populations, and (3) to identify barriers and facilitators to effective hospital participation in the 340B Program consistent with the policy’s goals. This proposal explicitly addresses AHRQ’s emphasis on the role of incentives in health care system performance (NOT-HS-14-005), with a focus on AHRQ priority populations including low-income and uninsured patients. It will generate novel and policy-relevant evidence on the 340B Program’s effects on patient care across all major payer groups and the uninsured. Results will also yield insights for safety net health care policymaking more broadly. The award will support Dr. Desai’s transition to independence and her long-term research agenda to inform policies that promote a reliable and high-quality health care system for the most vulnerable Americans.