Understanding Geographic Variation in Systemic Overuse Among the Privately Insured
Bibliographic Data
| ID | 9104906 |
|---|---|
| Authors | Allison H Oakes (0000-0003-1516-0034, Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, corresponding author), Aditi P Sen (0000-0002-7203-2736, Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, corresponding author), Jodi B Segal (0000-0003-3978-9662, Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, corresponding author) |
| Year | 2020 |
| Volume | 58 |
| Issue | 3 |
| Pages | 257-264 |
| Publication date | 2020-03-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000001271 |
| PMID | 32106167 |
| OpenAlex | W2994920803 |
| Language | EN |
| References cited | 39 |
BACKGROUND: Medical care overuse is a significant source of patient harm and wasteful spending. Understanding the drivers of overuse is essential to the design of effective interventions. OBJECTIVE: We tested the association between structural factors of the health care delivery system and regional differences systemic overuse. RESEARCH DESIGN: We conducted a retrospective analysis of deidentified claims for 18- to 64-year-old adults from the IBM MarketScan Commercial Claims and Encounters Database. We calculated a semiannual Johns Hopkins Overuse Index for each of the 375 Metropolitan Statistical Areas in the United States, from January 2011 to June 2015. We fit an ordinary least squares regression to model the Johns Hopkins Overuse Index as a function of regional characteristics of the health care system, adjusted for confounders and time. RESULTS: The supply of regional health care resources was associated with systemic overuse in commercially insured beneficiaries. Regional characteristics associated with systemic overuse included number of physicians per 1000 residents (P=0.001) and higher Medicare malpractice geographic price cost index (P<0.001). Regions with a higher density of primary care physicians (P=0.008) and a higher proportion of hospital-based providers (P=0.016) had less systemic overuse. Differences in hospital and insurer market power were inversely associated with systemic overuse. CONCLUSIONS: Systemic overuse is associated with observable, structural characteristics of the regional health care system. These findings suggest that interventions that aim to improve care efficiency via reductions in overuse should focus on the structural drivers of this phenomenon, rather than on the eradication of individual overused procedures
Confounding · Descriptive statistics · Family medicine · Health care · Health services research · Medical prescription · Psychological intervention · Public health · Economic and Financial Impacts of Cancer · Emergency Medicine · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Internal Medicine · Medicine · Nursing
The Triple Aim
The Implications of Regional Variations in Medicare Spending. Part 2
Eliminating Waste in US Health Care
Evaluating the Quality of Medical Care
The Implications of Regional Variations in Medicare Spending. Part 1
Contribution of Primary Care to Health Systems and Health
Identifying Possible Indicators of Systematic Overuse of Health Care Procedures With Claims Data
An Index for Measuring Overuse of Health Care Resources With Medicare Claims
Partitioning Variance in Multiple Regression Analyses as a Tool for Developing Learning Models
The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured
| Citation velocity | historical |
|---|---|
| Highly cited | No |