Pricing of Major Cancer Surgeries: Impact of Insurance, Outcomes, and Severity

说明(由申请人提供)：本提案侧重于在医院环境下进行的三种外科手术的定价：结肠切除术(结肠切除术)、肺手术(切除术)和子宫(子宫内膜)切除术及其变种，当与结直肠癌、肺癌和子宫癌的诊断相关时。手术的选择是基于非可自由支配的，门诊替代的可能性有限，但有明确的交易价格。感兴趣的主要研究问题是价格的分散，保险对价格的影响，以及汇总到医院水平的结果的作用。我们将确定从按服务收费到严格管理医疗等不同类型的计划能够从医院获得价格折扣的程度。此外，我们将通过再住院率、死亡率和与癌症诊断相关的并发症发生率来衡量更高的价格在多大程度上反映了更好的结果。我们的零假设是，价格的地理分散性及其差异很高，管理式医疗计划获得了更大的折扣，医院癌症结果的改善得到了市场的回报。分析将使用一个大型的私人保险个人索赔数据库进行，其中包含临床信息和实际付款，即交易价格。核心数据将得到MEDPAR行政数据的补充，用于估计基于人口的结果，以及其他具有市场级和县级变量的文件。2002年至2006年的定价数据将汇集在一起，由于滞后的价值，以前的年份将在其他文件中使用。历年的价格将根据医疗通胀进行调整。将使用各种计量经济学和流行病学技术来说明保险计划的选择和在结果中实施风险调整。我们将使用一个认识到保险和结果都是内生的框架，将医院水平的结果衡量标准和保险选择变量纳入价格方程。我们将为每种类型的手术和两个关键价格定义中的每一个估计单独的模型：接触(手术)价格和剧集(入院)价格。与公共卫生相关：到目前为止，关于癌症护理价格分布的信息很少。除了填补这一空白，我们的研究还将告知患者/消费者和第三方支付者在根据潜在的医疗质量根据价格做出选择时的权衡。这种理解还将有助于在医疗保健环境中为未来的政策决策提供参考，因为医疗保健环境越来越受到不断上升的成本的制约。

DESCRIPTION (provided by applicant): This proposal focuses on pricing of three surgical procedures performed in hospital settings: colectomy (colon resection), lung surgery (resection) and a uterine (endometrial) hysterectomy and their variants, when associated with the diagnosis of colorectal, lung and uterine cancers. Procedures were chosen on the basis of being non-discretionary, with limited possibility for outpatient substitution, but having well defined transaction prices. The main research questions of interest are the dispersion of prices, the impact of insurance on prices, and the role of outcomes aggregated to the level of the hospital. We will determine the extent to which different types of plans ranging from fee-for-service to strict managed care are able to obtain price discounts from hospitals. Additionally, we will determine the extent to which higher prices reflect better outcomes as measured by hospital rates of readmissions, mortality, and complication rates associated with cancer diagnoses. Our null hypotheses are that geographic dispersion of prices and their variance is high, managed care plans capture greater discounts, and improved cancer outcomes at hospitals are rewarded by markets. The analysis will be performed using a large database of claims for privately insured individuals, containing clinical information and actual payments, i.e., transaction prices. Core data will be augmented by MEDPAR administrative data for estimating population based outcomes, and by other files with market- level and county level variables. Pricing data will be pooled for the years 2002-2006, with prior years used in other files due to lagged values. Prices across years will be adjusted for medical inflation. Various econometric and epidemiological techniques will be employed to account for insurance plan selection and for implementing risk-adjustment in outcomes. We will incorporate hospital-level outcome measures and insurance choice variables into price equations using a framework that recognizes that both insurance and outcomes are endogenous. We will estimate separate models for each type of procedure and for each of the two key definitions of price: contact (surgery) price and episode (admissions) price. PUBLIC HEALTH RELEVANCE: To date there has been a paucity of information on the distribution of prices for cancer care. In addition to filling this gap, our research will inform both patient/consumers and third-party-payers about trade-trade offs in making choices on the basis of price in terms of potential quality of care. This understanding will also help inform future policy decisions in a health care setting that is increasingly constrained by escalating costs.