Reimbursement Policy and Cancer Chemotherapy

描述（由申请人提供）：几年来，医疗保险支付给肿瘤医生化疗药物的费用一直是一个相当有争议的问题。医疗保险现代化法案（MMA）改变了报销方式，有效地减少了肿瘤学家收到的加价，特别是昂贵的药物。在这项工作中，我们提出了一个回归不连续设计来研究这一变化对所有癌症患者开化疗处方的可能性的影响，如果开了化疗处方，所用药物的昂贵程度，以及化疗实施的环境。如果发现治疗改变，我们也会考虑对不良结果指标的影响。在之前的工作中，我们使用MMA之前的数据研究了一个类似的问题，以评估同一医生的化疗报销随时间变化以及不同携带者对治疗的影响。我们发现，获得高报酬的肿瘤学家不太可能给转移性癌症患者开化疗处方，但更有可能使用昂贵的药物。最近报销变化的复杂性质——药品支付大幅减少，但行政费用大幅增加——使得从先前的工作中预测MMA的影响变得困难。了解它对化疗模式的影响不仅对医疗保险支出有重要意义，而且对癌症受益人的福利也有重要意义。

DESCRIPTION (provided by applicant): Medicare payments to oncologists for chemotherapeutic agents have been a source of considerable controversy for several years. The Medicare Modernization Act (MMA) changed reimbursement methods, effectively reducing the markups oncologists receive, especially for expensive agents. In this work we propose a regression discontinuity design to study the effect of this change on the likelihood of prescribing chemotherapy to all cancer patients and, if chemotherapy is prescribed, the expensiveness of the agents used, and the setting in which chemotherapy is administered. If treatment changes are found, we will also consider the impact on indicators of untoward outcomes. In prior work we studied a similar question using data from before the MMA to assess the effect on treatment of variation in chemotherapy reimbursement to the same physician over time as well as across carriers. We found that more highly reimbursed oncologists were not more likely to prescribe chemotherapy to patients with metastatic cancer, but were more likely to use expensive agents. The complex nature of the recent reimbursement changes -- large reductions in payments for drugs but a significant increase in administrative fees -- makes predicting the MMA's effect from prior work difficult. Understanding its impact on chemotherapy treatment patterns has important implications not only for Medicare spending but also for the welfare of beneficiaries with cancer.