医生诊疗偏好与医疗支出：来自商业保险支付方的证据

中文摘要

我们考察了医生偏好与商业保险覆盖的心脏病发作患者所接受医疗服务的强度及成本之间的关系。我们发现，Cutler 等 (2019)（CSSW）基于调查收集的偏好度量指标能够预测医疗利用的变化，其符号与 CSSW 针对 Medicare 受益人在治疗和支出两方面发现的强关系方向相同，但幅度大幅减弱。此外，诊疗风格激进地区从商业保险机构获得的报销水平要低得多，以致诊疗偏好的差异与商业市场上的支出仅呈弱相关。我们构建了一个简洁的商业保险机构定价模型，该模型能够解释上述事实特征。

Abstract

We examine the relationship between physician preferences and both the intensity and cost of care delivered to commercially insured heart attack patients. We find that the survey-based preference measures collected by Cutler et al. (2019) (CSSW) predict variations in utilization that are same-signed, though substantially muted, relative to the strong relationships CSSW uncovered for both treatment and expenditure for Medicare beneficiaries. Additionally, regions with aggressive practice styles receive sufficiently lower reimbursements from commercial insurers that variations in practice preferences have weak correlations with expenditures in the commercial market. We present a parsimonious model of commercial insurers' pricing that can rationalize this fact pattern.