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引用次数: 0
摘要
我们估算了医院-医生纵向一体化对血液肿瘤科、眼科和风湿病科医生管理药物的支出和使用的影响。利用 2013 年至 2017 年医疗保险付费服务医疗索赔的 100% 样本,我们发现纵向一体化将治疗从医生办公室转移到了医院门诊部。伴随着这些转变,所有三个专科的每项手术中由医生管理的药物管理支出都有所增加。血液肿瘤专科医生的 B 部分药物支出也有所增加。与此同时,以接受药物输注/注射的受益人人数和药物输注次数来衡量的医生治疗强度在所有三个专科中都有所下降。这些结果表明,医疗保险报销制度的激励机制,尤其是医疗点支付差额和门诊药物报销率,与纵向整合相互作用,导致总体支出增加。相关政策和合并指南应努力限制纵向整合导致的支出增长。
Impact of hospital-physician vertical integration on physician-administered drug spending and utilization.
We estimate the effects of hospital-physician vertical integration on spending and utilization of physician-administered drugs for hematology-oncology, ophthalmology, and rheumatology. Using a 100% sample of Medicare fee-for-service medical claims from 2013 to 2017, we find that vertical integration shifts treatments away from physician offices and toward hospital outpatient departments. These shifts are accompanied by increases in physician-administered drug administration spending per procedure for all three specialties. Spending on Part B drugs also increases for hematologist-oncologists. At the same time, physician treatment intensity, as measured by the number of beneficiaries who receive drug infusions/injections and the number of drug infusions, decreases across all three specialties. These results suggest that the incentives of the Medicare reimbursement system, particularly site-of-care payment differentials and outpatient drug reimbursement rates, interact with vertical integration to lead to higher overall spending. Policies and merger guidelines should attempt to restrain spending increases attributed to vertical integration.
期刊介绍:
This Journal publishes articles on all aspects of health economics: theoretical contributions, empirical studies and analyses of health policy from the economic perspective. Its scope includes the determinants of health and its definition and valuation, as well as the demand for and supply of health care; planning and market mechanisms; micro-economic evaluation of individual procedures and treatments; and evaluation of the performance of health care systems.
Contributions should typically be original and innovative. As a rule, the Journal does not include routine applications of cost-effectiveness analysis, discrete choice experiments and costing analyses.
Editorials are regular features, these should be concise and topical. Occasionally commissioned reviews are published and special issues bring together contributions on a single topic. Health Economics Letters facilitate rapid exchange of views on topical issues. Contributions related to problems in both developed and developing countries are welcome.