Provider Payment Reform and Implications for Health Care Costs

描述（由申请人提供）：随着美国人口老龄化和医疗保健成本持续上升，旨在控制成本的政策已成为改革努力的主要焦点。医疗服务提供者支付改革是这些政策的核心。本研究的总体目的是了解提供者支付改革对医疗保健成本和医生行为的影响。拟议的研究主要是经验性的，但也有经济理论的成分。本项目将着重对私人计划环境下的一项大型支付改革政策进行实证评价。索赔和登记数据将用于研究改变医生群体对预期支付的报销对成本、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，即医生最佳转诊的规范模型和医生专业化的积极模型，以补充实证工作。

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.