Provider Payment Reform and Implications for Health Care Costs

描述(申请人提供)：随着美国人口老龄化和医疗成本的持续上升，旨在控制成本的政策已成为改革努力的主要重点。供应商支付改革是这些政策的核心。本研究的总体目标是了解医疗服务提供者付费改革对医疗费用和医生行为的影响。拟议的研究在很大程度上是实证的，但也有经济理论的组成部分。本项目将集中于对私人计划环境下的大额支付改革政策进行实证评估。索赔和登记数据将被用来研究将医生群体的报销改为预期付款对费用、利用率和医生转诊行为的影响。该项目还将开发两个简单的经济模型，一个是医生最佳转介的规范模型，另一个是医生专业化的积极模型，以补充实证工作。 公共卫生相关性：由于医疗机构支付改革是控制医疗成本的核心工具，了解支付改革如何影响医疗成本和质量是政策制定者和公共卫生官员的一个重要目标。拟议的项目为公共卫生和卫生政策界提供了对大型医疗服务提供者支付改革倡议的严格循证评估。

DESCRIPTION (provided by applicant): As the U.S. population ages and health care costs continue to rise, policies aimed to control costs have become a major focus of the reform effort. Provider payment reform is at the core of these policies. The overall aim of this research is to understand the implications of provider payment reform on health care costs and physician behavior. The proposed research is largely empirical, but there is an economic theory component. This project will center on an empirical evaluation of a large payment reform policy in a private plan environment. Claims and enrollment data will be used to study the effects of changing a physician group's reimbursement towards prospective payment on costs, utilization, and physician referral behavior. The project will also develop two simple economic models, a normative model of physician optimal referral and a positive model of physician specialization, to complement the empirical work. PUBLIC HEALTH RELEVANCE: As provider payment reform is a central tool for controlling health care costs, understanding how payment reform affects the cost and quality of care is an important objective for policymakers and public health officials. The proposed project provides the public health and health policy communities a rigorous evidence-based evaluation of a large provider payment reform initiative.