Costs and Quality of Primary Care Services: Implications for Community Health Centers

项目摘要/摘要 社区卫生中心(CHC)在美国卫生保健系统中发挥着至关重要的作用，它提供 为1300多人中约2600万医疗服务不足的人口提供初级保健 CHC不考虑患者的支付能力。鉴于这一使命，CHC历史上一直暴露在 金融风险相对较高。通过建立一个信托基金，联邦政府对社区卫生保健中心的资金大幅增加 根据《平价医疗法案》；然而，信托资金目前计划于2019年结束。金融界 随着国会考虑大幅削减对以下项目的拨款，社区卫生中心的前景进一步受到威胁 扩大医疗补助和市场补贴。 CHC的生存能力取决于可持续的财务健康状况。到目前为止，ACA对CHC影响的研究 财务业绩的重点是收入来源变化的影响。然而，财务利润率是 由收入和成本两部分组成。该项目在采用供应方方法方面是独一无二的 CHC绩效通过估算经济成本函数来实现，前提是企业的微观经济理论。在……里面 医疗保健、成本函数分析主要用于医院和疗养院的分析 文学作品。我们的项目是第一个将这些方法应用于CHC的研究。 我们建议使用一个独特且未得到充分利用的小组数据库来探索CHC成本并确定 CHC成本效率的驱动因素，因为它们与当前CHC面临的政策挑战有关。我们最初将提供 详细说明CHC成本各组成部分的国家水平差异，建立基准 对有政策意义的分组的估计，如医疗补助-扩张与非扩张州和高 与低医疗短缺地区的对比，以及2011-2018年研究期间的趋势。接下来，我们将构造密钥 CHC独有的变量，将作为CHC成本函数估算的构建块。其中包括一个 工资指数(劳动力投入价格)、资本成本衡量、设施案例组合指数和综合质量 得分。使用这些方法，我们将在我们的主要经验中估计多产品的Translog成本函数 在敏感性分析中，对半对数模型进行了规范和估计。我们将应用我们的成本计算结果 功能估计，以产生一组在解决与政策相关的问题时有用的结构。首先，我们将 评估CHC是否从服务扩展与收缩中节省了成本。第二，我们将 检查整合初级保健就诊和更多服务的潜在成本节约和互补性 中心的专门服务，特别是精神健康。第三，由于资金紧张可能会影响护理质量， 我们将探索CHC成本和护理质量之间的潜在权衡。

Project Summary/Abstract Community health centers (CHCs) play an essential role in the U.S. health care system by delivering primary care to a medically underserved population of approximately 26 million individuals in more than 1,300 CHCs regardless of patients' ability to pay. Given this mission, CHCs historically have been exposed to relatively high financial risk. Federal funding for CHCs increased substantially through a trust fund established under the Affordable Care Act; however, trust funding currently is scheduled to end in 2019. The financial outlook for CHCs is threatened further as Congress considers options to significantly reduce funding for Medicaid expansion and Marketplace subsidies. CHC viability depends upon sustainable financial health. To date, studies of the ACA impact on CHC financial performance have focused on the effects of changing sources of revenue. Yet financial margins are comprised of both revenue and cost components. This project is unique in taking a supply side approach to CHC performance by estimating economic cost functions premised on the microeconomic theory of the firm. In health care, cost function analyses have been used primarily in analyses in the hospital and nursing home literatures. Our project is the first study to apply these methods to CHCs. We propose to employ a unique and underutilized panel database to explore CHC costs and to identify drivers of CHC cost efficiency as they relate to current policy challenges facing CHCs. We initially will provide a detailed description of national level variation in various components of CHC costs, establishing baseline estimates for policy-meaningful groupings such as Medicaid-expansion versus non-expansion states and high versus low medical shortage areas, and trends in the 2011-2018 study period. Next we will construct key variables unique to CHCs that will serve as building blocks for CHC cost function estimation. These include a wage index (labor input price), a cost of capital measure, a facility case-mix index, and composite quality scores. Using these measures, we will estimate multi-product translog cost functions in our main empirical specification, and estimate semi-log models in sensitivity analyses. We will apply the results of our cost function estimations to produce a set of constructs useful in addressing policy-relevant issues. First, we will assess whether CHCs experience cost-savings from service expansion versus contraction. Second we will examine potential cost savings and complementarities from integrating primary care visits and more specialized services in centers, notably mental health. Third, as funding constraints may affect quality of care, we will explore the potential trade-off between CHC costs and quality of care.