ROLE OF TECHNOLOGY IN HEALTH CARE COST GROWTH

描述(由申请人提供)：大多数健康经济学家(81%)认为，医疗保健支出上升的主要原因是新医疗技术的开发、采用和利用不断增加。这项研究旨在扩大我们对技术在推动成本增长中的作用的理解。我们有三个目标： 1.评估哪些疾病对人口一级的保健费用增长贡献最大。 2.评估技术在推动成本增长方面的作用 3.评估自1996年以来影响成本增长的技术类型以及应用这些技术的患者类型。 为了实现这些目标，我们将采用两种研究方法。首先，将对一个大型行政索赔数据库进行回溯性分析，以确定哪些疾病对成本增长的贡献最大。这一分析将遵循残差法，以确定技术在推动成本增长中的作用。具体地说，就像文学作品一样，我们将根据不断变化的人口统计数据进行调整。与现有的许多文献相比，我们将能够以更详细的方式控制价格和保险设计的变化，以及地理人口的转移，鉴于医疗保健支出的横截面差异，这可能是重要的。根据文献，剩余成本的增长将归因于“技术”。因为在残差法中被贴上技术标签的很多东西实际上可能不是技术，我们将对医生进行一系列半结构化的采访，以更好地了解实践模式如何以及为什么发生了变化。这将使我们能够更详细地了解技术在决定成本增长方面的作用，并使我们能够解决具体的目标2和3。与这一领域的许多工作不同，我们将专注于商业保险人口，使我们能够就与雇主市场保费上涨相关的成本增长发表评论。此外，与现有的许多文献相比，我们将能够区分发病率的变化与资源使用的变化，条件是疾病发病率。发生率和有条件的资源使用都可能受到技术的影响。这些半结构化的访谈旨在让人们了解，相对于肥胖率上升等其他未被观察到的因素，科技是如何影响成本增长的这两个组成部分的。

DESCRIPTION (PROVIDED BY APPLICANT): Most health economists (81 percent) believe that the primary explanation for rising health care expenditures is the increasing development, adoption, and utilization of new medical technology. This study aims to extend our understanding of the role of technology in driving cost growth. We have three objectives: 1. To assess which diseases have contributed most to health care cost growth at the population level. 2. To assess the role of technology in contributing to cost growth 3. To assess the types of technology that have influenced cost growth since 1996 and the types of patients to which they have been applied. Two research methods will be used to accomplish these aims. First, retrospective analysis of a large administrative claims database will be conducted to identify which diseases have contributed most to cost growth. This analysis will follow the residual method for identifying the role of technology in driving cost growth. Specifically, like the literature, we will adjust for changing demographics. In contrast to much of the existing literature, we will be able to control, in a much more detailed way, for changing prices and insurance design as well as for geographic population shifts which might be important given the cross-sectional variation in health care spending. Following the literature, the residual cost growth will be attributed to "technology." Because much of what is labeled as technology in the residual method may not in fact be technology, we will conduct a series of semistructured interviews with physicians to better understand how and why practice patterns have changed. This will enable us to get a more detailed sense of the role of technology in determining cost growth and allow us to address specific aims 2 and 3. In contrast to much of the work in this area, we will focus on a commercially insured population, allowing us to comment on cost increases that relate to premium increases in the employer market. Also in contrast to much of the existing literature, we will be able to separate out changes in incidence from changes in resource use conditional on disease incidence. Both incidence and conditional resource use may be affected by technology. The semistructured interviews will be designed to provide some understanding of how technology has affected both of these components of cost growth, relative to other unobserved factors such as rising obesity rates.