Forum for Health Economics and Policy最新文献_第5页

Physician Self-Referral of Physical Therapy Services for Patients with Low Back Pain: Implications for Use, Types of Treatments Received and Expenditures 下腰痛患者物理治疗服务的医师自我转诊:使用的含义、接受的治疗类型和支出

Forum for Health Economics and Policy Pub Date : 2016-12-01 DOI: 10.1515/fhep-2015-0026

Jean M. Mitchell, J. Reschovsky, L. Franzini, E. A. Reicherter

{"title":"Physician Self-Referral of Physical Therapy Services for Patients with Low Back Pain: Implications for Use, Types of Treatments Received and Expenditures","authors":"Jean M. Mitchell, J. Reschovsky, L. Franzini, E. A. Reicherter","doi":"10.1515/fhep-2015-0026","DOIUrl":"https://doi.org/10.1515/fhep-2015-0026","url":null,"abstract":"Abstract Prior research on treatment of low back pain has documented large increases in use of spinal surgery, MRIs and lumbosacral injections linked to physician self-referral arrangements. No recent research has examined whether physician ownership of physical therapy services results in greater use of physical therapy to treat low back pain. The objective of this study is to investigate whether physician ownership of physical therapy services affects frequency of use, visits and types of physical therapy services received by patients with low back pain. Using claims records from insured patients covered by Blue Cross Blue Shield of Texas (2008–2011) we compared several metrics of use of physical therapy services for low back pain episodes controlling for self-referral status. We identified 158,151 low back pain episodes, 27% met the criteria to be classified as “self-referral.” Only 10% of “non-self-referral” episodes received physical therapy compared to 26% of self-referral episodes (p<0.001). The unadjusted and regression adjusted self-referral effect was identical – about 16 percentage point difference (p<0.001). Among patients who received some physical therapy, self-referral episodes were comprised of 2.26 fewer visits and 11 fewer physical therapy service units (p<0.001). Non-self-referring episodes included a significantly higher proportion of “active” (hands on or patient engaged) as opposed to “passive” treatments (p<0.001). The regression-adjusted difference was 30 percentage points when measured as actual counts and 29 percentage points when measured in RVUs (p<0.001). Total spending on back-related care was 35% higher for self-referred episodes compared to their non-self-referred counterparts (p<0.001). Ownership of physical therapy services influence physicians’ referral to initiate a course of physical therapy to treat low back pain, but also affect the types of physical therapy services a patient receives.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88955261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Estimating Regression-Based Medical Care Expenditure Indexes for Medicare Advantage Enrollees 基于回归的医保优惠参保人医疗支出指标估算

Forum for Health Economics and Policy Pub Date : 2016-12-01 DOI: 10.1515/fhep-2015-0031

A. Hall

引用次数: 1

Evidence of Inefficiencies in Practice Patterns: Regional Variation in Medicare Medical and Drug Spending 实践模式效率低下的证据:医疗保险医疗和药物支出的地区差异

Forum for Health Economics and Policy Pub Date : 2016-12-01 DOI: 10.1515/fhep-2015-0034

Melinda Buntin, T. Hayford

{"title":"Evidence of Inefficiencies in Practice Patterns: Regional Variation in Medicare Medical and Drug Spending","authors":"Melinda Buntin, T. Hayford","doi":"10.1515/fhep-2015-0034","DOIUrl":"https://doi.org/10.1515/fhep-2015-0034","url":null,"abstract":"Abstract Several studies have explored the causes and magnitude of geographic variation in Medicare spending and service use, but most of these studies have not taken into account that pharmaceuticals may substitute for medical service use. We address this issue using Medicare medical and pharmaceutical administrative claims data to explore the correlation between medical and pharmaceutical spending and utilization; we also examine medical and pharmaceutical use for subsets of the Medicare population with certain chronic conditions often treated with drugs. Beneficiary-level regressions with controls for health status and demographics were used to construct standardized medical spending and pharmaceutical spending and utilization measures for each region and patient cohort. Areas with higher medical spending tend to have higher pharmaceutical spending in general. However, areas with higher medical spending also tend to have lower pharmaceutical spending for conditions for which prescription drugs may substitute for additional medical care. Both of these patterns are consistent with less efficient medical practices in higher-spending areas. Likewise, more expensive drugs and more broad-spectrum antibiotics, which are often considered discretionary and overused, are more likely to be prescribed in higher-spending areas. Our results suggest that care may be provided more efficiently in some regions than in others. However, additional research is needed to investigate relationships between spending and health care outcomes, and what types of policies may create incentives for higher-spending regions to reduce spending without a loss in quality.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75570006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

The Impact of Delayed Hepatitis C Viral Load Suppression on Patient Risk: Historical Evidence from the Veterans Administration 延迟丙型肝炎病毒载量抑制对患者风险的影响:来自退伍军人管理局的历史证据

Forum for Health Economics and Policy Pub Date : 2016-12-01 DOI: 10.1515/fhep-2015-0041

T. Matsuda, J. Mccombs, I. Tonnu-Mihara, J. McGinnis, D. Fox

{"title":"The Impact of Delayed Hepatitis C Viral Load Suppression on Patient Risk: Historical Evidence from the Veterans Administration","authors":"T. Matsuda, J. Mccombs, I. Tonnu-Mihara, J. McGinnis, D. Fox","doi":"10.1515/fhep-2015-0041","DOIUrl":"https://doi.org/10.1515/fhep-2015-0041","url":null,"abstract":"Abstract Background: The high cost of new hepatitis C (HCV) treatments has resulted in “watchful waiting” strategies being developed to safely delay treatment, which will in turn delay viral load suppression (VLS). Objective: To document if delayed VLS adversely impacted patient risk for adverse events and death. Methods: 187,860 patients were selected from the Veterans Administration’s (VA) clinical registry (CCR), a longitudinal compilation of electronic medical records (EMR) data for 1999–2010. Inclusion criteria required at least 6 months of CCR/EMR data prior to their HCV diagnosis and sufficient data post-diagnosis to calculate one or more FIB-4 scores. Primary outcome measures were time-to-death and time-to-a composite of liver-related clinical events. Cox proportional hazards models were estimated separately using three critical FIB-4 levels to define early and late viral response. Results: Achieving an undetectable viral load before the patient’s FIB-4 level exceed pre-specified critical values (1.00, 1.45 and 3.25) effectively reduced the risk of an adverse clinical events by 33–35% and death by 21–26%. However, achieving VLS after FIB-4 exceeds 3.25 significantly reduced the benefit of viral response. Conclusions: Delaying VLS until FIB-4 >3.25 reduces the benefits of VLS in reducing patient risk.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85676893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Quantifying Gains in the War on Cancer Due to Improved Treatment and Earlier Detection 由于治疗的改进和早期检测，量化癌症战争中的收益

Forum for Health Economics and Policy Pub Date : 2016-06-01 DOI: 10.1515/fhep-2015-0028

S. Seabury, D. Goldman, Charu N. Gupta, Z. Khan, A. Chandra, T. Philipson, D. Lakdawalla

{"title":"Quantifying Gains in the War on Cancer Due to Improved Treatment and Earlier Detection","authors":"S. Seabury, D. Goldman, Charu N. Gupta, Z. Khan, A. Chandra, T. Philipson, D. Lakdawalla","doi":"10.1515/fhep-2015-0028","DOIUrl":"https://doi.org/10.1515/fhep-2015-0028","url":null,"abstract":"Abstract Introduction: There have been significant improvements in both treatment and screening efforts for many types of cancer over the past decade. However, the effect of these advancements on the survival of cancer patients is unknown, and many question the value of both new treatments and screening efforts. Methods: This study uses a retrospective analysis of SEER Registry data to quantify reductions in mortality rates for cancer patients diagnosed between 1997 and 2007. Using variation in trends in mortality rates by stage of diagnosis across cancer types, we use logistic regression to decompose separate survival gains into those attributable to advances in treatment versus advances in detection. We estimate the gains in survival due to gains in both treatment and detection overall and separately for 15 of the most common cancer types. Results: We estimate that 3-year cancer-related mortality of cancer patients fell 16.7% from 1997 to 2007. Overall, advances in treatment reduced mortality rates by approximately 12.2% while advances in early detection reduced mortality rates by 4.5%. The relative importance of treatment and detection varied across cancer types. Improvements in detection were most important for thyroid, prostate and kidney cancer. Improvements in treatment were most important for non-Hodgkins lymphoma, lung cancer and myeloma. Conclusion: Both improved treatment options and better early detection have led to significant survival gains for cancer patients diagnosed from 1997 to 2007, generating considerable social value over this time period.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72585464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 7

Salience and Health Campaigns 突出和健康运动

Forum for Health Economics and Policy Pub Date : 2016-06-01 DOI: 10.1515/fhep-2014-0019

Markus Dertwinkel-Kalt

引用次数: 42

Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities 竞争溢出效应和熟练护理机构的监管剥削

Forum for Health Economics and Policy Pub Date : 2016-06-01 DOI: 10.1515/fhep-2014-0006

J. Bowblis, Christopher S. Brunt, D. Grabowski

引用次数: 9

How Effective is Population-Based Cancer Screening? Regression Discontinuity Estimates from the US Guideline Screening Initiation Ages 以人群为基础的癌症筛查有多有效?美国指南筛选起始年龄的回归不连续估计

Forum for Health Economics and Policy Pub Date : 2016-06-01 DOI: 10.1515/fhep-2014-0014

S. Kadiyala, E. Strumpf

{"title":"How Effective is Population-Based Cancer Screening? Regression Discontinuity Estimates from the US Guideline Screening Initiation Ages","authors":"S. Kadiyala, E. Strumpf","doi":"10.1515/fhep-2014-0014","DOIUrl":"https://doi.org/10.1515/fhep-2014-0014","url":null,"abstract":"Abstract We estimate the marginal benefits of population-based cancer screening by comparing cancer test and detection rates on either side of US guideline-recommended initiation ages (age 40 for breast cancer and age 50 for colorectal cancer during the study period). Using a regression discontinuity design and self-reported test data from national health surveys, we find test rates for breast and colorectal cancer increase at the guideline age thresholds by 109% and 78%, respectively. Data from cancer registries in twelve US states indicate that cancer detection rates increase at the same thresholds by 50% and 49%, respectively. We estimate significant effects of screening on earlier breast cancer detection (1.2 cases/1000 screened) at age 40 and colorectal cancer detection (1.1 cases/1000 individuals screened) at age 50. Forty-eight and 73% of the increases in breast and colorectal case detection occur among middle-stage cancers (localized and regional) with most of the remainder among early-stage (in-situ). Our analysis suggests that the cost of detecting an asymptomatic case of breast cancer at age 40 via population-based screening is $107,000–134,000 and that the cost of detecting an asymptomatic case of colorectal cancer at age 50 is $473,000–485,000.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84120848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 14

Returns to Society from Investment in Cancer Research and Development 癌症研发投资回报社会

Forum for Health Economics and Policy Pub Date : 2016-06-01 DOI: 10.1515/fhep-2014-0022

A. Chandra, J. MacEwan, A. Campinha-Bacote, Z. Khan

{"title":"Returns to Society from Investment in Cancer Research and Development","authors":"A. Chandra, J. MacEwan, A. Campinha-Bacote, Z. Khan","doi":"10.1515/fhep-2014-0022","DOIUrl":"https://doi.org/10.1515/fhep-2014-0022","url":null,"abstract":"Abstract Background: Since the start of the War on Cancer there have been enormous investments in improving oncology treatment. The return to society generated by this investment is unknown. We estimate the returns generated over the previous four decades and extrapolate future returns from current investment in cancer R&D. Methods: Using data on cancer incidence, mortality, and treatment-specific R&D expenditures from 1973 to 2010, we used regression models and two-sided significance tests to relate investment in cancer treatment R&D to cancer mortality, by tumor type. For investment, we used a measure of the knowledge stock generated by cancer treatment R&D expenditures over the previous 25 years to capture the cumulative benefits of past innovations and advances in treatment. Results: Investment of an additional $1 million in cervical, breast, colorectal, and prostate cancer between 1973 and 1990 was associated with a cumulative return of more than $5 million from cancer R&D by 2010. Through 2010, investment in cancer R&D was associated with average benefits in excess of costs in all but two cancers, ovarian and pancreatic. Regarding future returns, we estimated that each additional $1 million invested in cancer treatment research and development in 2010 will produce over $28 million in value over the following 50 years. Conclusions: The return to society from spending on cancer treatment R&D is large, but varies across tumor types.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85055437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Demand-Side Factors Associated with the Purchase of Long-Term Care Insurance 与购买长期护理保险相关的需求方因素

Forum for Health Economics and Policy Pub Date : 2016-06-01 DOI: 10.1515/fhep-2014-0020

M. Unruh, D. Stevenson, R. Frank, Marc Cohen, D. Grabowski

引用次数: 4