阶层医生网络计划和专家医生的患者选择
Elena Prager1,2, Vilsa E Curto3, Alexa Magyari4
1Simon Business School, University of Rochester, Rochester, New York.
JAMA network open
|November 9, 2023
概括
层级医生网络 (TPN) 计划不会随着时间的推移显著影响患者选择的医生. 这些健康计划并没有加剧健康不平等或患者自付费用.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 患者的行为患者的行为
背景情况:
- 层级医生网络 (TPN) 的健康计划通过减少共同支付,激励患者选择成本更低,质量更高的医生.
- 最初的TPN实施表明患者转向更高价值的提供者.
研究的目的:
- 调查TPN与患者医生选择的长期关联 (8-12年).
- 评估TPN是否加剧了与患者自付费用和获得较低代价医生的医疗不平等相关的健康不平等.
主要方法:
- 采用46645名医生和585399名患者的医疗保险索赔数据进行的横截面研究.
- 回归不连续性和差异分析分析检查了医生级别排名和新患者市场份额的共同支付差异.
- 通过旅行距离和患者收入水平的共同付款来评估获得的公平性.
主要成果:
- 医生级别排名或共同支付差异与新患者市场份额之间没有发现任何关联.
- 收入较低的患者比收入较高的患者支付的平均共同支付略低.
- 长期来看,TPN对患者的医生选择没有显著的指导作用.
结论:
- 在长时间内,TPN可能在引导患者向价值更高的医生方面存在局限性.
- 研究的TPN与医生接入或费用方面的健康不公平性增加无关.
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