Physician Distribution and Health Care Access, Costs, And Quality

描述（由申请人提供）：尽管许多研究报告了美国不同地理区域医生分布的不平等，但仍然缺乏关于医生供应更多的地区是否更容易获得医疗保健和质量更好的研究。此外，已发表的研究没有提供令人信服的证据来说明这种关系的性质。它是线性的，即增加供应与稳步改善的机会和质量相关联，还是有一个阈值，超过这个阈值，机会和质量的改善与医生供应的增加趋于平稳？拟议的项目旨在通过分析使用大型国家数据集来填补文献中的这些空白，这些数据集尚未被先前的研究使用。拟议项目的目标是帮助建立一个证据基础，可以告知医生劳动力政策。它有以下具体目标：具体目标1：评估医生供应如何影响未满足的需求和通常的护理来源方面获得护理。具体目标二：为了调查医生供应对不同类型卫生服务利用的影响，重点是（1）可避免的住院和非紧急问题的艾德就诊，这两种类型的利用可以通过改善初级卫生保健的可及性来减少;和（2）“供应敏感服务”，如住院和专家就诊。具体目标3：研究医生供给对（a）年度卫生保健总支出和（B）不同类型卫生服务的年度支出的影响，包括医生办公室就诊、艾德就诊和住院服务。具体目标4：使用AHRQ的医疗保健提供者和系统的消费者评估（CAHPS）计划中的措施来检查医生供应对医疗保健质量的影响。拟议的项目符合目前AHRQ研究组合领域的“价值组合”和“创新和新兴领域组合”。特别是，它将使用AHRQ的医疗支出小组调查（MEPS）来评估医生供应的变化如何影响美国人的医疗保健获得，使用，支出和质量，包括AHRQ的优先人群，如儿童，妇女，老年人和慢性病患者。

DESCRIPTION (provided by applicant): Despite numerous studies reporting on the unequal distribution of physicians across geographic areas in the U.S, there remains a dearth of research on whether health care is more accessible and quality is better in areas with more physician supply. Furthermore, the published studies do not provide convincing evidence on the nature of the relationship. Is it linear, whereby increasing supply is associated with steadily improved access and quality, or is there a threshold above which improvements in access and quality level off with increases in physician supply? The proposed project aims to fill these gaps in the literature by analyzing use large national datasets, which have not been used by prior research. The goal of the proposed project is to help build an evidence base that can inform physician workforce policy. It has the following specific aims: Specific Aim 1: To assess how physician supply affects access to care in terms of unmet needs and usual source of care. Specific Aim 2: To investigate the effect of physician supply on utilization of different types of health services, with a focus on (1) avoidable hospitalizations and ED visits for non-urgent problems, both types of utilization could be reduced through improved access to primary health care; and (2) "supply-sensitive services," such as hospitalizations and visits to specialists. Specific Aim 3: To examine the effect of physician supply on (a) total annual health care expenditures and (b) annual expenditures on different types of health services, including doctor office visits, ED visits, and inpatient services. Specific Aim 4: To examine the effect of physicia supply on health care quality using measures from the AHRQ's program of Consumer Assessment of Healthcare Providers and Systems (CAHPS). The proposed project fits within the current AHRQ Research Portfolio areas of "Value Portfolio" and "Innovations and Emerging Areas Portfolio". In particular, it will use the AHRQ's Medical Expenditure Panel Survey (MEPS) to assess how changes in physician supply affect health care access, use, expenditures, and quality for Americans, including the AHRQ's priority populations, such as children, women, elders, and those with chronic conditions.