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探讨医疗保健支出的变化——实践模式的作用是什么?

Exploring variations in health-care expenditures-What is the role of practice styles?

机构信息

Department of Economics, Johannes Kepler University Linz, Austria.

Christian Doppler Laboratory Aging, Health, and the Labor Market, Austria.

出版信息

Health Econ. 2020 Jun;29(6):683-699. doi: 10.1002/hec.4011. Epub 2020 Feb 20.

Abstract

Variations in medical resource usage, both across and within geographical regions, have been widely documented. In this paper, we explore physician practice styles as a possible determinant of these variations. In particular, we exploit patient mobility between physicians to identify practice styles among general practitioners (GPs) in Austria. We use a large administrative data set containing detailed information on a battery of different health-care services and implement a model with additive patient and GP fixed effects that allows flexibly for systematic differences in patients' health states. We find that, although GPs explain only a small part of the overall variation in medical expenses, heterogeneities in spending patterns among GPs are substantial. Conditional on patient characteristics, we document a difference of € 751.47 per patient per year in total medical expenses (which amounts to roughly 45% of the sample mean) between high- and low-spending GPs.

摘要

医疗资源的使用在地域间和地域内都存在广泛的差异。在本文中,我们探讨了医生的行医风格是否是导致这些差异的一个可能因素。具体来说,我们利用医生之间的患者流动来识别奥地利全科医生(GP)的行医风格。我们使用了一个包含详细信息的大型行政数据集,其中包括一系列不同的医疗服务,并实施了一个具有加性患者和 GP 固定效应的模型,该模型可以灵活地考虑患者健康状况的系统差异。我们发现,尽管全科医生仅能解释医疗费用总变异的一小部分,但全科医生的支出模式存在很大的异质性。在考虑了患者特征的情况下,我们记录了高支出和低支出 GP 之间每位患者每年的总医疗费用差异为 751.47 欧元(约占样本平均值的 45%)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b96/7187477/dcb585da6567/HEC-29-683-g001.jpg

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