Department of Health Administration and Policy, George Mason University, 4400 University Drive, MS 2G7 Fairfax, VA 22030, USA.
Mathematica Policy Research, 1100 1st Street, NE, 12th Floor, Washington, DC 20002-4221, USA.
Health Econ Rev. 2014 May 9;4:8. doi: 10.1186/s13561-014-0008-4. eCollection 2014.
To identify associations between market factors, especially relative reimbursement rates, and the probability of surgery and cost per episode for three medical conditions (cataract, benign prostatic neoplasm, and knee degeneration) with multiple treatment options.
We use 2004-2006 Medicare claims data for elderly beneficiaries from sixty nationally representative communities to estimate multivariate models for the probability of surgery and cost per episode of care as a function local market factors, including Medicare physician reimbursement for surgical versus non-surgical treatment and the availability of primary care and specialty physicians. We used Symmetry's Episode Treatment Groups (ETG) software to group claims into episodes for the three conditions (n = 540,874 episodes).
Higher Medicare reimbursement for surgical episodes and greater availability of the relevant specialists are significantly associated with more surgery and higher cost per episode for all three conditions, while greater availability of primary care physicians is significantly associated with less frequent surgery and lower cost per episode.
Relative Medicare reimbursement rates for surgical vs. non-surgical treatments and the availability of both primary care physicians and relevant specialists are associated with the likelihood of surgery and cost per episode.
确定市场因素（特别是相对报销率）与三种具有多种治疗选择的医疗条件（白内障、良性前列腺增生和膝关节退变）的手术概率和每例费用之间的关联。
我们使用 2004-2006 年来自六十个全国代表性社区的老年受益人的医疗保险索赔数据，根据当地市场因素（包括医疗保险对手术与非手术治疗的医师报销以及初级保健医生和专科医生的可及性），估计手术概率和每例护理费用的多元模型。我们使用 Symmetry 的 Episode Treatment Groups（ETG）软件将三种疾病的索赔分组为多个病例（n=540874 个病例）。
较高的医疗保险对手术病例的报销和更多相关专科医生的可用性与所有三种疾病的更多手术和更高的每例费用显著相关，而更多的初级保健医生的可用性与较低的手术频率和较低的每例费用显著相关。
医疗保险对手术与非手术治疗的相对报销率以及初级保健医生和相关专科医生的可用性与手术概率和每例费用有关。
