Department of Health Administration and Policy, College of Health and Human Services, George Mason University, 4400 University Dr., MSN 2G7, Fairfax, VA 22030, USA.
Health Serv Res. 2011 Oct;46(5):1333-61. doi: 10.1111/j.1475-6773.2011.01276.x. Epub 2011 May 24.
To estimate the relationship between variations in medical spending and health outcomes of the elderly.
1992-2002 Medicare Current Beneficiary Surveys.
We used instrumental variable (IV) estimation to identify the relationships between alternative measures of elderly Medicare beneficiaries' medical spending over a 3-year observation period and health status, measured by the Health and Activity Limitation Index (HALex) and survival status at the end of the 3 years. We used the Dartmouth Atlas End-of-Life Expenditure Index defined for hospital referral regions in 1996 as the exogenous identifying variable to construct the IVs for medical spending.
DATA COLLECTION/EXTRACTION METHODS: The analysis sample includes 17,438 elderly (age >64) beneficiaries who entered the Medicare Current Beneficiary Survey in the fall of each year from 1991 to 1999, were not institutionalized at baseline, stayed in fee-for-service Medicare for the entire observation period, and survived for at least 2 years. Measures of baseline health were constructed from information obtained in the fall of the year the person entered the survey, and changes in health were from subsequent interviews over the entire observation period. Medicare and total medical spending were constructed from Medicare claims and self-reports of other spending over the entire observation period.
IV estimation results in a positive and statistically significant relationship between medical spending and better health: 10 percent greater medical spending over the prior 3 years (mean=U.S.$2,709) is associated with a 1.9 percent larger HALex value (p=.045; range 1.2-2.2 percent depending on medical spending measure) and a 1.5 percent greater survival probability (p=.039; range 1.2-1.7 percent).
On average, greater medical spending is associated with better health status of Medicare beneficiaries, implying that across-the-board reductions in Medicare spending may result in poorer health for some beneficiaries.
评估医疗支出变化与老年人健康结果之间的关系。
1992-2002 年医疗保险当前受益人调查。
我们使用工具变量（IV）估计来确定替代的老年人医疗保险受益人的医疗支出衡量指标与健康状况之间的关系，健康状况通过健康和活动限制指数（HALex）和 3 年后的生存状况来衡量。我们使用 1996 年为医院转诊区域定义的达特茅斯地图集临终支出指数作为外生识别变量，为医疗支出构建 IV。
资料收集/提取方法：分析样本包括 1991 年至 1999 年每年秋季进入医疗保险当前受益人调查的 17438 名老年人（年龄>64 岁）受益人，在基线时没有住院，在整个观察期内保持按服务收费的医疗保险，并且至少存活 2 年。基线健康状况的衡量标准是从该人进入调查的当年秋季获得的信息中构建的，健康状况的变化是从整个观察期内的后续访谈中得出的。医疗保险和总医疗支出是根据整个观察期内的医疗保险索赔和其他支出的自我报告构建的。
IV 估计结果表明，医疗支出与更好的健康状况之间存在正相关且具有统计学意义：前 3 年增加 10%的医疗支出（平均值为 2709 美元）与 HALex 值增加 1.9%相关（p=.045；取决于医疗支出衡量标准，范围为 1.2%-2.2%），生存概率增加 1.5%（p=.039；范围为 1.2%-1.7%）。
平均而言，更多的医疗支出与医疗保险受益人的健康状况更好相关，这意味着全面削减医疗保险支出可能会导致一些受益人的健康状况恶化。
