Essays on Geographic Variations in Medical Expenditures and Utilization in the Military Health System
Abstract
Over 40 years ago, researchers first documented geographic variations in the provision of health care in the United States. Recently, scholars have focused their investigations on understanding the causes and mechanisms of variations to help inform health policy. This work consists of three essays focused on identifying and understanding health care variations in the Military Health System (MHS). The first paper characterizes geographic variations in health care spending and utilization among TRICARE Prime beneficiaries. I find surprisingly large variations in expenditures of up to 70 across catchment areas. By leveraging patient migration, I am able to separate patient-level determinants of variations, which movers take with them, from place-specific factors which remain constant. These results suggest that variations in the MHS are overwhelmingly attributable to place-level factors (80-90 ). This study not only has landmark implications for policy in the MHS (spending could be potentially reduced by up to 32 system wide), but also motivates further research to understand what features unique to location could cause the differences in how seemingly similar patients are treated. One plausible hypothesis is that physicians might contribute to geographic variations. Using a novel dataset of physician characteristics, I find that variations in the cost and complication rates of bariatric procedures vary widely, but that these variations are predominately explained by patients health status and not by any observable characteristics of the surgeon. Complications result in inpatient stays, which cost 32 more on average. These findings suggest that efforts to improve surgical quality could not only result in better care for patients, but could also reduce expenditures while improving the surgical readiness of physicians. Finally, in the third paper, I use migrating physicians to understand the degree to which physicians alter their practice patterns
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 20, 2018
- Accession Number
- AD1128468
Entities
People
- William P. Luan
Organizations
- Uniformed Services University of the Health Sciences