医师竞争和低价值医疗保健

IF 3.1 2区 经济学 Q1 ECONOMICS American Journal of Health Economics Pub Date : 2021-12-13 DOI:10.1086/718509
Anthony Scott, Jinhu Li, H. Gravelle, M. McGrail
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引用次数: 5

摘要

尽管各国在卫生保健方面实施了有利于竞争的改革,以降低成本和提高质量,但关于竞争对医生提供的护理质量的影响的证据有限。我们研究了竞争对全科医生提供低价值、无效或有害的医疗保健服务的影响。我们在澳大利亚的全科医生咨询中使用丰富的患者水平数据,并衡量与其他全科医生的距离。我们的研究发现,面对更多竞争的全科医生会为腰痛和非并发症的急性支气管炎安排更多的影像学检查,从而降低护理质量。我们发现,竞争对咳嗽和感冒抗生素处方的影响类似,但较小且不显著。由于全科医生的信念和患者对护理有效性的期望不同,以及需求、成本和利润的差异,竞争在不同情况下可能产生混合影响。
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Physician Competition And Low-Value Health Care
Although countries have implemented pro-competitive reforms in health care to reduce costs and improve quality, there is limited evidence on the effect of competition on quality of care provided by physicians. We study the effect of competition on the provision of low-value—ineffective or harmful—health care by general practitioners (GPs). We use rich patient-level data on GP consultations in Australia and measure competition as distance to other GPs. Our study found that GPs facing more competition provide lower quality of care by ordering more imaging for low back pain and uncomplicated acute bronchitis. We find similar but smaller and insignificant effects of competition on prescribing antibiotics for coughs and colds. Competition can have mixed effects across different conditions because of differences in GPs’ beliefs and patient expectations about the effectiveness of care, as well as differences in demand, costs, and profit.
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来源期刊
CiteScore
4.30
自引率
2.70%
发文量
34
期刊介绍: The American Journal of Health Economics (AJHE) provides a forum for the in-depth analysis of health care markets and individual health behaviors. The articles appearing in AJHE are authored by scholars from universities, private research organizations, government, and industry. Subjects of interest include competition among private insurers, hospitals, and physicians; impacts of public insurance programs, including the Affordable Care Act; pharmaceutical innovation and regulation; medical device supply; the rise of obesity and its consequences; the influence and growth of aging populations; and much more.
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