Medicaid Physician Fee and Avoidable Hospitalization

描述（由申请人提供）：摘要ACA增加支付给为医疗补助患者服务的初级保健医生的费用的规定部分基于合理的直觉，即提高初级保健的医疗补助费用将改善医生的获得和使用。 服务，并反过来改善健康，例如，通过减少ACS条件的住院人数。然而，只有有限的证据支持这种直觉。我们提议的研究将填补公共卫生知识的空白。我们建议进行一项综合研究的影响，医疗补助费用的门诊服务和住院服务，衡量的门诊护理敏感（ACS）的条件。ACS条件是一个特别相关的结果，因为它们是与接受初级保健密切相关的健康指标。检查医疗补助医生费用和ACS入院之间的关联对政策也很重要，因为住院服务代表了对更高费用的潜在重要“抵消”。事实上，如果更高的医疗补助医生费用确实减少了ACS的入院人数，那么从这种减少中节省下来的钱就有机会支付费用的增加。我们提出的研究的全面性，其中将包括检查门诊和住院服务，将使我们能够提供一个更完整的会计比目前可用的机制，做或不联系医疗补助医生费用的健康。我们将确定费用对门诊服务使用的影响和费用对ACS住院的影响。结合这些分析将使我们能够推断出更大的初级保健之间的联系，由于更高的费用和ACS条件。具体来说，我们将使用非老化样本的数据（即，非双重资格）医疗补助受助人做以下事情：1.获得对初级保健的医疗补助费用与医疗补助受助人使用医生服务、实验室和成像服务以及其他门诊服务之间关联的估计。2.获得初级保健医疗补助费用与认为适合初级保健的条件（通常称为可避免或门诊护理敏感（ACS）住院）的入院概率之间的关联估计值。这将是第一次研究这个问题。

DESCRIPTION (provided by applicant): Summary The ACA provision to increase the fees paid to primary care physicians who serve Medicaid patients is based partly on the plausible intuition that raising Medicaid fees for primary care will improve access to, and use of, physician services and in turn improve health, for example, by reducing the number of hospital admissions for ACS conditions. However, there is only limited evidence to support this intuition. Our proposed research will fill in the gaps in public health knowledge. We propose to conduct a comprehensive study of the effect of Medicaid fees on outpatient services and inpatient services, as measured by ambulatory-care sensitive (ACS) conditions. ACS conditions are a particularly relevant outcome because they are measures of health that are tightly linked to receipt of primary care. Examining the association between Medicaid physician fees and ACS admissions is also important for policy because inpatient services represent a potentially important "offset" to higher fees. Indeed, if higher Medicaid physician fees do reduce ACS admissions, then savings from such a reduction has the chance to pay for the fee increase. The comprehensive nature of our proposed research, which will include examining both outpatient and inpatient services, will allow us to provide a more complete accounting than is currently available of the mechanisms that do or do not link Medicaid physician fees to health. We will identify the effect of fees on the use of outpatient services and the effect of fees on ACS inpatient admissions. Combining these analyses will allow us to infer the link between greater primary care due to higher fees and ACS conditions. Specifically, we will use data on a sample of non-aged (i.e., non-dual eligible) Medicaid recipients to do the following:1. Obtain estimates of associations between Medicaid fees for primary care and the use of physician services, laboratory and imaging services, and other outpatient services of Medicaid recipients. 2. Obtain estimates of associations between Medicaid fees for primary care and the probability of admission to the hospital for conditions thought to be amenable to primary care that are often referred to as avoidable or ambulatory- care sensitive (ACS) hospitalizations. This will be the first study to examine this question.