University of New Mexico, Department of Economics, 1 University of New Mexico, MSC05 3060, Albuquerque, NM, 87131-1161, United States.
Econ Hum Biol. 2021 May;41:100961. doi: 10.1016/j.ehb.2020.100961. Epub 2020 Nov 28.
Policies increasing healthcare availability might decrease the cost of delaying accessing of care, leading to potential negative consequences if patients delay treatment. We analyze a policy designed to increase access to kidney transplantation through the use of time since dialysis inception to prioritize patients for transplant, which was piloted at 26 of the 271 kidney transplant centers in the United States in 2006 and 2007. We model the patient's optimization problem comparing the benefits and costs of early waitlisting and predict that the policy change will lead to delayed waitlisting. To empirically test this prediction, we use difference-in-differences fixed effects panel regression techniques to analyze data on patients who began dialysis between 1/1/2000 and 12/31/2009. The results support the model's prediction; patients on dialysis who waitlist for kidney transplantation increase pre-waitlist dialysis duration by 11.6 percent or approximately 76 days from a pre-policy mean of 652 days (SD = 654). With regard to waitlist outcomes, the policy is associated with a 4.5 percentage point decrease in the probability of receiving a deceased donor transplant, somewhat offset by a 3.0 percentage point increase in the probability of receiving a live donor transplant. On the extensive margin, patients on dialysis decrease their likelihood of ever waitlisting by 1.5 percentage points. We find an increase in pre-waitlist dialysis time and a decrease in the likelihood of waitlisting at all, especially among populations likely to have experienced increased access to transplantation through the policy change: patients self-identifying as Black or Hispanic rather than Non-Hispanic White, and patients without private insurance. These results suggest that some individuals may not benefit if their access to care increases, if the increase in access sufficiently decreases the penalty of delaying accessing of care.
增加医疗保健可及性的政策可能会降低延迟获得护理的成本，如果患者延迟治疗，可能会产生潜在的负面后果。我们分析了一项旨在通过使用透析开始以来的时间来优先考虑患者进行移植的政策，该政策于 2006 年和 2007 年在美国 271 个肾移植中心中的 26 个中心进行了试点。我们通过比较早期等待名单的收益和成本来对患者的优化问题进行建模，并预测政策变化将导致等待名单延迟。为了实证检验这一预测，我们使用差分差异固定效应面板回归技术分析了 2000 年 1 月 1 日至 2009 年 12 月 31 日期间开始透析的患者的数据。结果支持模型的预测；等待肾移植的透析患者将等待名单上的透析时间延长 11.6%，即从政策前的平均 652 天（SD=654）延长约 76 天。就等待名单结果而言，该政策与接受已故供体移植的概率降低 4.5 个百分点有关，但通过活体供体移植的概率增加 3.0 个百分点得到部分抵消。在广泛的范围内，透析患者等待名单的可能性降低了 1.5 个百分点。我们发现，等待名单上的透析时间增加，等待名单的可能性降低，尤其是在经历了政策变化后，获得移植的机会增加的人群中：患者自我认同为黑人或西班牙裔，而不是非西班牙裔白人，以及没有私人保险的患者。这些结果表明，如果增加获得护理的机会，如果增加的机会足以降低延迟获得护理的惩罚，那么一些人可能不会受益。
