Medicaid Physician Fee and Avoidable Hospitalization

描述(由申请人提供)摘要：ACA条款增加支付给为医疗补助患者服务的初级保健医生的费用，部分是基于这样一种似是而非的直觉，即提高初级保健费用将改善获得和使用医生的机会 例如，通过减少因急性冠脉综合征而入院的人数，改善服务，进而改善健康状况。然而，支持这一直觉的证据有限。我们提出的研究将填补公共卫生知识的空白。我们建议就医疗补助费用对门诊和住院服务的影响进行一项全面的研究，以门诊护理敏感(ACS)条件衡量。急性冠脉综合征的情况是一个特别相关的结果，因为它们是健康的衡量标准，与接受初级保健密切相关。检查医疗补助医生费用和急性冠脉综合征入院人数之间的关系对于政策也很重要，因为住院服务代表着对更高费用的潜在重要的“抵消”。事实上，如果更高的医疗补助医生费用确实减少了急性冠脉综合征的入院人数，那么通过这种减少节省的资金就有机会支付费用的增加。我们拟议的研究将包括检查门诊和住院服务，这将使我们能够提供比目前可用的更完整的关于将医疗补助医生费用与健康联系起来或不联系起来的机制的核算。我们将确定费用对门诊服务使用的影响以及费用对急性冠脉综合征住院患者的影响。结合这些分析，我们将能够推断由于更高的费用而导致的更多初级保健与急性冠脉综合征病情之间的联系。具体地说，我们将使用非老年(即非双重资格)医疗补助受助人样本的数据来完成以下工作：1.获得初级保健医疗补助费用与使用医疗补助受助人的医生服务、实验室和成像服务以及其他门诊服务之间的关联估计。2.获得初级保健的医疗补助费用与入院概率之间的关系的估计，这些情况被认为符合初级保健的条件，通常被称为可避免或门诊护理敏感(ACS)住院治疗。这将是第一次研究这个问题。

DESCRIPTION (provided by applicant): Summary The ACA provision to increase the fees paid to primary care physicians who serve Medicaid patients is based partly on the plausible intuition that raising Medicaid fees for primary care will improve access to, and use of, physician services and in turn improve health, for example, by reducing the number of hospital admissions for ACS conditions. However, there is only limited evidence to support this intuition. Our proposed research will fill in the gaps in public health knowledge. We propose to conduct a comprehensive study of the effect of Medicaid fees on outpatient services and inpatient services, as measured by ambulatory-care sensitive (ACS) conditions. ACS conditions are a particularly relevant outcome because they are measures of health that are tightly linked to receipt of primary care. Examining the association between Medicaid physician fees and ACS admissions is also important for policy because inpatient services represent a potentially important "offset" to higher fees. Indeed, if higher Medicaid physician fees do reduce ACS admissions, then savings from such a reduction has the chance to pay for the fee increase. The comprehensive nature of our proposed research, which will include examining both outpatient and inpatient services, will allow us to provide a more complete accounting than is currently available of the mechanisms that do or do not link Medicaid physician fees to health. We will identify the effect of fees on the use of outpatient services and the effect of fees on ACS inpatient admissions. Combining these analyses will allow us to infer the link between greater primary care due to higher fees and ACS conditions. Specifically, we will use data on a sample of non-aged (i.e., non-dual eligible) Medicaid recipients to do the following:1. Obtain estimates of associations between Medicaid fees for primary care and the use of physician services, laboratory and imaging services, and other outpatient services of Medicaid recipients. 2. Obtain estimates of associations between Medicaid fees for primary care and the probability of admission to the hospital for conditions thought to be amenable to primary care that are often referred to as avoidable or ambulatory- care sensitive (ACS) hospitalizations. This will be the first study to examine this question.