医疗保险现场支付政策,医生实践特征和瘤学家垂直整合之间的关联
Xin Hu1, Ian McCarthy2,3, K Robin Yabroff4
1Department of Public Health Sciences, University of Virginia Comprehensive Cancer Center and School of Medicine, Charlottesville, VA.
JCO oncology practice
|July 2, 2024
概括
医疗保险的现场支付政策对瘤科医生垂直整合产生了不同的影响. 服务量和多样性等实践特征比支付政策更强烈地推动了整合.
科学领域:
- 卫生经济学 卫生经济学
- 瘤学实践管理的管理
- 医疗保健政策分析
背景情况:
- 医疗保险的差异性现场支付激励医院和医生的整合.
- 对这种激励对瘤学家的影响的证据是不一致的.
- 了解推动瘤学垂直整合的因素对于政策评估至关重要.
研究的目的:
- 检查医疗保险的现场支付政策与瘤学家的垂直整合之间的关联.
- 评估医生实践特征 (服务量,多样性) 在瘤学家垂直整合中的作用.
- 分析2013-2019年的数据,以了解瘤学家整合的趋势.
主要方法:
- 使用的医疗保险提供者使用和支付数据 (2013-2019).
- 定义垂直整合为向医院门诊部门 (HOPD) 收费超过10%的服务.
- 使用多变量线性概率回归来分析支付政策和整合之间的关系,根据实践特征进行调整.
主要成果:
- 医院办公室支付比率从2013年的1.63增加到2018年的1.99.
- 较高的医院办公室比率显示,在调整为实践特征后,与整合的负相关性较弱.
- 增加的服务量,服务多样性和城市位置与更高的垂直整合率显著相关.
结论:
- 瘤学家的实践特征是垂直整合的更有影响力的驱动因素,而不是医疗保险的现场支付政策.
- 调查结果质疑了旨在阻止瘤学垂直整合的场所中立支付改革的有效性.
- 政策考虑应纳入实践层面的因素,以实现医疗整合所需的结果.
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