IMPACT OF MGD CARE ON DEMAND FOR PREVENTIVE & CURATIVE M

我们提出了一项新的计量经济学研究，研究管理医疗对医疗服务的预防和治疗利用的影响——这一主题在有关公共和私人医疗保健系统的设计和改革的研究和政策辩论中占据中心位置。该提案承认，许多现有的调查医疗利用管理式护理影响的定量和计量经济学研究存在缺陷。首先，大多数实证研究是基于观察数据，因此遭受内生性偏差造成的自我选择进入管理医疗。其次，很少有研究是基于具有全国代表性的样本。第三，那些没有受到前两种批评的研究是基于旧数据的，所以他们的结论可能不能推广到现在。本文提出了一种新的计量经济学方法来分析管理式医疗在健康利用中的作用。我们建议使用1996年医疗支出小组调查，并将重点放在拥有某种形式的私人医疗保险的非老年人的子样本上。我们计划检查两种类型的利用率变量。首先是一套预防性保健服务措施。第二组利用率变量是更常用的访问不同类型的提供者的措施。管理式护理的效果是通过两个变量来衡量的，这两个变量是对不同类型提供者的访问的更常用的衡量标准。管理式医疗的效果可以通过两个变量来衡量，即加入HMO和加入其他类型的管理式医疗计划。我们的计量经济模型将涉及两组联合因变量：一个方程解释HMO或其他管理式医疗计划的登记情况，另一个方程解释一些利用措施。结果变量是离散的随机变量，需要使用非线性模型。在这种情况下，内生性偏差的出现导致了显著的计量经济学复杂性。这些复杂的问题将使用现代计算机密集型方法来处理。

We propose a new econometric study of the effects of managed care on preventive and curative utilization of health services - - a topic which occupies a central place in research and policy debates regarding the design and reform of public and private health care systems. The proposal recognizes that many existing quantitative and econometric studies that investigate the impact of managed care of medical utilization are flawed. First, most empirical studies are based on observational data and hence suffer from endogeneity bias caused by self- selection into managed care. Second, few of the studies are based on nationally representative samples. Third, those studies that are not subject to the two preceding criticisms are based on old data, so their conclusions may not generalize to the present. This proposal puts forward new econometric methodology for analyzing the role of managed care in health utilization. We propose to use the 1996 Medical Expenditure Panel Survey and focus on the sub-sample of non-elderly adults who have some form of private health insurance. We plan to examine two types of utilization variables. The first is a set of measures of preventive care services. The second set of utilization variables are more commonly used measures of visits to different types of providers. The effect of managed care is captured via two variables, which are more commonly used measures of visits to different types of providers. The effect of managed care is captured via two variables, enrollment in an HMO and enrollment in other types of Managed Care plans. Our econometric models will involve two sets of jointly dependent variables: an equation to explain enrollment in HMO or other managed care plan, and an equation to explain some measure of utilization. The outcome variables are discrete random variables that require use of nonlinear models. The occurrence of endogeneity bias in this context leads to significant econometric complications. These complications will be handled using modern computer-intensive methods.