住院培训地区的支出模式以及医疗保险受益人的执业医生提供的护理后续支出
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
概括
医生支出模式受到他们接受培训的地方的影响,在高成本住院地区的支出更高. 在高开支地区接受培训的早期职业生涯医生的医疗保险费用明显更高,这表明住院培训会影响未来的医疗保健支出.
科学领域:
- 卫生经济学 卫生经济学
- 医学教育 医学教育
- 医疗保健政策 医疗保健政策
背景情况:
- 研究生医学教育可能会塑造医生长期的实践习惯.
- 关于医生住院培训地点对医生支出模式的影响的研究有限.
研究的目的:
- 调查医生住院培训地区的支出水平与每位受益人随后的医疗保险支出之间的关联.
- 确定研究生医学教育的地理成本是否会影响医生的财务行为.
主要方法:
- 2011年医疗保险索赔数据的多层次多变量分析,用于家庭医学和内科医生.
- 匹配医生住所位置与达特斯阿特拉斯医院推区域 (HRRs),按支出分类 (低,平均,高).
- 根据培训HRR支出水平,对患者,社区和医生特征进行控制,比较每个受益人的平均医疗保险支出.
主要成果:
- 在支出较高的地区接受培训的医生,与在支出较低的地区接受培训的医生相比,每位受益人的医疗保险支出更高,特别是在执业的早期.
- 在低支出和高支出培训HRR之间观察到患者支出的7%差异,翻译为估计522美元的差异.
- 这种支出差异随着时间的推移而减少,在医生16-19年后的医生之间没有发现显著的差异.
结论:
- 住院培训地点与随后的医生医疗保险支出模式有关.
- 在研究生医学教育期间的干预措施可能为管理未来医疗保健支出提供战略.
- 实习生培训对支出的影响在职业生涯早期最为强烈.
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