Causes and Consequences of Health Care Intensity

描述（由申请人提供）：社会经济地位和种族显然与许多健康问题的治疗和结果的巨大差异有关，并且有证据表明这种差异随着时间的推移而增加。 但对这种变化的原因知之甚少。 它们是患者偏好还是医生行为的结果？ 地理因素在差异中的作用也没有得到很好的理解：例如，非洲裔美国人得到的医疗服务较少，是因为他们碰巧生活在总体利用率较低的地区吗？ 项目4的重新提交将通过检查供应商，地区和政策因素，治疗和健康结果之间的关系，为这些问题提供新的证据。 我们将 检查医生，医院和区域特征与治疗和结果差异的关系。 Oaxaca-Blinder分解将用于估计治疗模式以及结局差异与种族和收入的相关性。 估计治疗的差异在多大程度上反映了患者的偏好。 使用拟议的患者偏好调查（核心C补充），将按受访者的年龄、性别和种族对规模、范围和监测强度的偏好进行比较。 衡量在获得高质量医疗保健方面解释黑白和收入差异的因素。 使用医疗保险索赔数据和医疗保险当前受益人调查，我们将解决非洲裔美国人或低收入老年患者是否被收治到质量较低的医院，如果是，为什么。 考虑技术创新对心脏病发作（AMI）住院后健康结果差异不断扩大的作用。 手术创新在不同种族和地区的传播差异将被用来估计技术在健康结果不平等加剧中的作用。 确定政策变化对老年人口的治疗和健康差异的影响，重点关注两个发生重大变化的重要领域：（a）医疗补助资格和（B）不成比例共享医院（DSH）计划，这两个计划都增加了对服务于大量弱势群体的医院的补偿。

DESCRIPTION (provided by applicant): Socioeconomic status and race are clearly associated with large differences in treatments and outcomes for many health problems, and there is evidence that such disparities are increasing over time. But relatively little is known about the causes of such variations. Are they the consequence of patient preferences or physician behavior? Nor is the role of geography in disparities well understood: do African-Americans, for example, receive less care because they happen to live in regions with lower overall utilization rates? This resubmission of Project 4 will provide new evidence on these issues by examining the relationships among variations in provider, area, and policy factors, treatments and health outcomes. We will Examine the relationship of physician, hospital and regional characteristics to differences in treatments and outcomes. Oaxaca-Blinder decompositions will be used to estimate how treatment patterns, as well as outcome differences, are associated with race and income. Estimate to what extent differences in treatments reflect the patient preferences. Using the proposed Survey of Patient Preferences (Core C Supplement), preferences for scale, scope, and surveillance intensity will be compared by age, sex and race of respondent. Measure factors that explain Black-White and income differences in access to high quality health care. Using the Medicare claims data and the Medicare Current Beneficiary Survey, we will address whether African-American or low income elderly patients are admitted to lower quality hospitals and, if so, why. Consider the role of technological innovation on the rising disparities in health outcomes following hospital admissions for heart attacks (AMI). Variations in the diffusion of surgical innovations across race and region will be used to estimate the role of technology in the rising inequality in health outcomes. Determine the effects of policy changes on treatment and health disparities in the elderly population by focusing on two important areas where there have been significant changes: (a) Medicaid eligibility and (b) the Disproportionate Share Hospital (DSH) program, both of which increased reimbursements to hospitals serving large disadvantaged populations.