Pricing of Major Cancer Surgeries: Impact of Insurance, Outcomes, and Severity

主要癌症手术的定价：保险、结果和严重程度的影响

基本信息

批准号：
7736987
负责人：
AVI DOR
金额：
$ 47.75万
依托单位：
GEORGE WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-01 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7736987
关键词：
Accounting Address Admission activity Affect Area Body of uterus Breast Caring Cell Size Characteristics Charge Clinical Colectomy Colon Colorectal Complication Continuity of Patient Care Contracts Coronary County Data Data Analyses Data Files Databases Diagnosis Diffuse Economic Inflation Endometrial Endometrial Carcinoma Epidemiologic Methods Equation Excision Fee-for-Service Plans Future Generic Drugs Genus Cola Geographic Locations Health Maintenance Organizations Healthcare Healthcare Market Heart Diseases Hospital Charges Hospitals Hysterectomy Individual Inpatients Insurance Insurance Carriers Literature Lung Malignant Neoplasms Malignant neoplasm of cervix uteri Malignant neoplasm of lung Malignant neoplasm of ovary Malignant neoplasm of prostate Managed Care Marketing Measurement Measures Mediation Medicaid Medical Medicare Methodology Modeling Multivariate Analysis Operative Surgical Procedures Outcome Outcome Measure Outpatients Patients Penetration Performance Policies Policy Maker Preferred Provider Organizations Price Private Sector Procedures Provider Proxy Public Health Quality of Care Radiation therapy Regulation Relative (related person)Reporting Research Resources Rewards Risk Risk Adjustment Role Sampling Services Severities Signal Transduction Site Specificity State Hospitals Structure Summary Reports System Testing Third-Party Payer Tumor Debulking Uterine Cancer Variant Work administrative database base cancer care cancer diagnosis cancer surgery cancer therapy capitate bone care episode cost design discount discounting hospital analysis improved insight interest minimally invasive mortality payment population based pressure price lists programs public health relevance research study statistics trait willingness to pay

项目摘要

DESCRIPTION (provided by applicant): This proposal focuses on pricing of three surgical procedures performed in hospital settings: colectomy (colon resection), lung surgery (resection) and a uterine (endometrial) hysterectomy and their variants, when associated with the diagnosis of colorectal, lung and uterine cancers. Procedures were chosen on the basis of being non-discretionary, with limited possibility for outpatient substitution, but having well defined transaction prices. The main research questions of interest are the dispersion of prices, the impact of insurance on prices, and the role of outcomes aggregated to the level of the hospital. We will determine the extent to which different types of plans ranging from fee-for-service to strict managed care are able to obtain price discounts from hospitals. Additionally, we will determine the extent to which higher prices reflect better outcomes as measured by hospital rates of readmissions, mortality, and complication rates associated with cancer diagnoses. Our null hypotheses are that geographic dispersion of prices and their variance is high, managed care plans capture greater discounts, and improved cancer outcomes at hospitals are rewarded by markets. The analysis will be performed using a large database of claims for privately insured individuals, containing clinical information and actual payments, i.e., transaction prices. Core data will be augmented by MEDPAR administrative data for estimating population based outcomes, and by other files with market- level and county level variables. Pricing data will be pooled for the years 2002-2006, with prior years used in other files due to lagged values. Prices across years will be adjusted for medical inflation. Various econometric and epidemiological techniques will be employed to account for insurance plan selection and for implementing risk-adjustment in outcomes. We will incorporate hospital-level outcome measures and insurance choice variables into price equations using a framework that recognizes that both insurance and outcomes are endogenous. We will estimate separate models for each type of procedure and for each of the two key definitions of price: contact (surgery) price and episode (admissions) price. PUBLIC HEALTH RELEVANCE: To date there has been a paucity of information on the distribution of prices for cancer care. In addition to filling this gap, our research will inform both patient/consumers and third-party-payers about trade-trade offs in making choices on the basis of price in terms of potential quality of care. This understanding will also help inform future policy decisions in a health care setting that is increasingly constrained by escalating costs.

描述（由申请人提供）：该提案的重点是在医院环境中执行的三种手术程序的定价：结肠切除术（结肠切除），肺手术（切除）和子宫（子宫内膜）子宫切除术及其变体，与大肠，肺和子宫癌的诊断有关。基于非危险的基础选择程序，门诊替代的可能性有限，但交易价格明确。感兴趣的主要研究问题是价格的分散，保险对价格的影响以及汇总到医院水平的结果的作用。我们将确定不同类型的计划的程度，从支付费用到严格的托管护理能够从医院获得价格折扣。此外，我们将确定较高的价格反映在多大程度上通过与癌症诊断相关的住院，死亡率和并发症率的医院率来衡量的。我们的无效假设是，价格及其差异很高，托管护理计划获得了更大的折扣，并且医院的癌症成果得到了改善。该分析将使用包含临床信息和实际付款（即交易价格）的私人保险人的大量索赔数据库进行分析。 MEDPAR管理数据将增强核心数据，以估计基于人群的结果以及其他具有市场级别和县级变量的文件。定价数据将在2002 - 2006年期间汇总，由于滞后值而在其他文件中使用了先前的几年。多年的价格将调整以进行医疗通货膨胀。将采用各种计量经济学和流行病学技术来说明保险计划的选择并实施结果的风险调整。我们将使用一个框架将医院级别的结果指标和保险选择变量纳入价格方程，该框架认识到保险和结果都是内源性的。我们将针对每种类型的程序以及价格的两个关键定义估算单独的模型：联系（手术）价格和发作（入学）价格。公共卫生相关性：迄今为止，关于癌症护理价格分配的信息很少。除了填补这一空白外，我们的研究还将告知患者/消费者和第三方付款人有关贸易贸易折扣，以根据潜在的护理质量为基础做出选择。这种理解还将有助于在医疗保健环境中逐渐限制成本限制的医疗保健环境中的未来政策决策。