レジデンス研修の地域における支出パターンと,メディケア受給者に対して実務医によって提供されるケアに対する,その後の支出
Candice Chen1, Stephen Petterson2, Robert Phillips3
1Department of Health Policy, Milken Institute School of Public Health, George Washington University, Washington, DC2Dr Chen is now with the Health Resources and Services Administration, Rockville, Maryland.
JAMA
|December 10, 2014
まとめ
医者の支出パターンは,彼らが訓練された場所によって影響を受け,高コストのレジデンス地域では支出が高くなります. 高支出地域で訓練された早期キャリアの医師は,メディケアのコストが大幅に高く,レジデンス研修が将来の医療費に影響を及ぼすことを示唆しました.
科学分野:
- 健康経済学 医療経済学
- 医療教育 医療教育について
- 保健医療政策について
背景:
- 医学の大学院教育は,医師の長期の実践習慣を形作る可能性があります.
- 医者の支出パターンに対するレジデンス研修の場所の影響に関する研究は限られている.
研究 の 目的:
- 医者のレジデンス研修地域の支出水準と,受給者一人当たりのメディケア支出との関連性を調査する.
- 医学研究生教育の地理的コストが,医師の財務行動に影響するかどうかを判断する.
主な方法:
- 2011年のメディケア保険請求データに関する多層次多変量分析. 家族医学と内科の医師のためのデータ.
- ドートマス・アトラス病院の推薦地域 (HRRs) と医者の在籍所を支出 (低,平均,高) により分類した位置をマッチング.
- 訓練HRRの支出レベル,患者,コミュニティ,医師の特徴を制御した受益者あたりの平均メディケア支出を比較する.
主要な成果:
- 高支出地域で研修を受けた医師は,低支出地域で研修を受けた医師と比較して,受益者一人当たりのメディケア支出が高く,特に実務の初期には高額であった.
- 低支出と高支出の研修HRRの間では,患者の支出の7%の差が観察され,推定522ドルの差に変換されました.
- この支出の格差は,時間の経過とともに減少し,医者の間で16〜19年の住居後の有意な違いは見つかりませんでした.
結論:
- レジデンス研修の場所は,後の医師のメディケア支出パターンと関連しています.
- 医学の大学院教育における介入は,将来の医療費の管理のための戦略を提供することができる.
- レジデンス研修が支出に与えるインプリント効果は,キャリアの初期段階において最も強く見られる.
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