PUBLIC POLICY TOWARD LIVING WILLS

作为调查法律影响的长期研究工作的一部分 和老年人医疗保健的公共政策，这个项目将 评估管理生前遗嘱的法律对医疗的影响 老年人的决策、卫生保健成本和卫生保健结果。 该项目有四个主要目标。第一个是编译和 整合关于生前遗嘱变化的全面国家数据和 1984-1995年间的其他法律以及医院层面的纵向数据和 关于医疗决策、健康的纵向个人级别数据 一系列老年人的护理费用和保健结果 医疗条件。第二个目标是确定 对生前遗嘱影响最大的老年患者， 包括那些患有重病和濒临死亡的人。这个 第三个目标是确定生前遗嘱法律变化的决定因素和 其他州法律改革。 第四个目标是评估不同生活维度的影响 将法律和这些关于医疗模式的法律的变化， 医疗保健成本和健康结果，重点关注 受生前遗嘱公共政策影响最大的老年人。 由于生前遗嘱法律经常包含多项条款， 潜在的相反影响，该项目将单独确定 不同维度的法律变化对患者和患者的影响 医生的决策和健康结果。此外，该项目 将调查生前遗嘱法律是否与医院互动 特点、地区特点和其他影响医疗的规律 治疗模式。我们的方法识别公共政策的效果 通过比较生前遗嘱的强度和强度随时间的趋势 来自将法律改为患者的州的患者的结果 来自那些没有这样做的州。因为生前遗嘱的作用完全是 由州法律规定，这些方法将直接解决关键的 公共利益问题：不同类型的生前遗嘱法律， 赋予患者不同的权利，影响治疗决定，健康 医疗费用和健康结果？

As part of a long-term research effort investigating the impact of laws and public policies on health care for the elderly, this project will estimate the effects of laws governing living wills on medical treatment decisions, health care costs, and health care outcomes in the elderly. The project has four main objectives. The first is to compile and integrate comprehensive national data on changes to living will and other laws from 1984-1995 with longitudinal hospital-level data and longitudinal individual-level data on medical treatment decisions, health care costs, and health care outcomes in the elderly for a range of medical conditions. The second goal is to identify subpopulations of elderly patients for whom living wills have the greatest impact, including those with major illness and those near the end-of-life. The third goal is to identify the determinants of living will law changes and other state legal reforms. The fourth goal is to assess the effect of different dimensions of living will laws and changes in these laws on medical treatment patterns, health care costs, and health outcomes, focusing on subpopulations of elderly individuals most affected by public policy toward living wills. Since living will laws frequently contain multiple provisions with potentially opposing impacts, the project will identify separately the influence of different dimensions of law changes on patient and physician decision-making and health outcomes. In addition, the project will investigate whether living will laws interact with hospital characteristics, area characteristics, and other laws influencing medical treatment patterns. Our methods identify the effect of public policies toward living wills by comparing trends over time in intensity and outcomes for patients from states that changed their laws to patients from states that did not. Because the role of a living will is completely specified by state law, these methods will directly address the crucial public question of interest: how do different types of living will laws, that grant patients different rights, affect treatment decisions, health care costs, and health outcomes?