Pricing of Hospital Cardiac Procedures: Impacts of Federal Quality Reports

 描述(由申请人提供)：公开报道的医院质量衡量标准旨在支持消费者的决策，并激励医院检查和改进其护理过程。在一个运转良好的市场中，医院提供良好健康结果的能力应该会带来更大的消费者需求和医院更强的讨价还价能力，并从更高的价格中获得回报。然而，研究未能发现高质量的信息影响了患者对美国医院的选择。此外，对影响私人协商的医院价格的因素也知之甚少。这个项目建议研究一个尚未探索的渠道，通过这个渠道，医院质量信息的公开报告可能会影响医疗保健市场，并最终影响患者，即私营部门的医院定价。我们将研究美国医院和私营保险公司之间的交易价格与医疗保险和医疗补助服务中心(CMS)在医院比较网站上公开报告的医院死亡率和再次入院人数之间的关系。我们将解决这些目标：目标1：使用价格分散的替代测量和市场区域的替代定义来衡量和描述医院交易价格的分布。目的2：评估医院比较质量排名对心脏手术价格的影响，并根据医院特征、保险公司特征、市场结构、病例严重性和其他患者特征进行调整。目的3：确定实施医院比对对心脏手术价格水平的影响。方法：我们将使用2005-2012年的MarketScan(注册商标)研究数据库来确定因心脏手术住院的患者。这些数据将通过医院提供商编号链接到CMS医院比较数据和美国医院协会年度调查数据库。使用线性回归模型，我们将估计患者水平的价格方程，其中手术的实际交易价格作为因变量。我们将研究医院的风险调整死亡率和再住院率与价格的关系，控制患者和程序的异质性，以及衡量医院和保险公司的相对议价能力。准实验技术将被用来评估医院比较对医院市场和价格的影响。

 DESCRIPTION (provided by applicant): Publicly reported measures of hospital quality are intended to support consumer decision- making and to motivate hospitals to examine and improve their processes of care. In a well- functioning market, a hospital's ability to deliver goo health outcomes should lead to greater consumer demand and increased bargaining power for the hospital, and be rewarded by higher prices. Yet research has failed to find that quality information has impacted patients' choice of U.S. hospitals. Moreover, there is very little understanding of the factors that influence privately negotiated hospital prices. This project proposes examination of a yet unexplored channel though which public reporting of hospital quality information might be found to impact health care markets, and ultimately patients, namely private sector hospital pricing. We will examine the relationship between prices transacted between U.S. hospitals and private insurers and measures of hospital mortality and readmissions publicly reported by the Centers for Medicare and Medicaid Services (CMS) on the Hospital Compare website. We will address these aims: Aim 1: Measure and describe the distribution of hospital transaction prices using alternative measures of price dispersion, and alterative definitions of market areas. Aim 2: Estimate the impact of Hospital Compare quality rankings on prices of cardiac procedures, adjusted for hospital characteristics, insurer characteristics, market structures, case severity, and other patient characteristics. Aim 3: Determine the impact of implementation of Hospital Compare on price levels of cardiac procedures. Methods: We will use The MarketScan(R) Research Database for the years 2005-2012 to identify inpatient hospital admissions for cardiac procedures. These will be linked by hospital provider number to the CMS Hospital Compare data and to the American Hospital Association Annual Survey Database. Using linear regression models, we will estimate patient level price equations, in which the actual transacted price for the procedure serves as the dependent variable. We will examine the association of risk adjusted mortality rates and readmission rates of the hospital with prices, controlling for patient and procedure heterogeneity as well as measures of the relative bargaining power of hospitals and insurers. Quasi-experimental techniques will be used to evaluate the impact of Hospital Compare on hospital markets and prices.