(NAS Colloquium) Science, Technology and the Economy (1996) / Chapter Skim
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Are the returns to technological change in health care declining?
Are the returns to technological change in health care declining?
Pages 47-54
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From page 47... ...
In particular, the methods compare trends in the net effects on mortality and costs of treatment by more intensive hospitals for "marginal" patients, patients whose hospital choice differs across the IV groups. Thus, the IV methods estimate the effects of the additional technologies available at more intensive hospitals on incremental AMI patients, those whose admission choice and hence treatment is affected by differential access to intensive hospitals.
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From page 48... ...
49.8 5.7 30.1 1.6 12.8 1.2 18.8 6.1 9.8 40.7 20.0 48.7 33.9 10.5 11.7 2.10 20.4 7.3 7.2 35.6 42.5 $16,788 $1S,301 Age (SD) Female Black Rural Cancer Pulmonary disease Dementia Diabetes Renal disease Cerebrovascular disease Initial admit to hospital with catheterization by 1984 Initial admit to hospital adopting catheterization 1985-1990 Initial admit to high-volume hospital 90-day catheterization rate 90-Day PTCA rate 90-Day CABG rate 1-year admissions 1-year total hospital days 1-year total special care unit days 1-day mortality rate 1-year mortality rate 2-year mortality rate 1-year total hospital costs (1991 dollars)
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From page 49... ...
Catheterization rates for 1984 AMI patients were approximately 7.9 percentage points higher for patients initially admitted to hospitals with catheterization capabilities than for patients initially admitted to hospitals without cath eterization. Acquiring catheterization had a fundamental effect on treatment intensity: in 1990, catheterization rates for patients admitted to hospitals that adopted catheterization during the study period were closer to rates at hospitals that had previously adopted catheterization (rates 0.1 percentage points lower than noncatheterization hospitals in 1984 but 10 points higher in 1990~.
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From page 50... ...
U.S. elderly AMI patients, 1984-1990: Patient treatments and outcomes by hospital type at initial admission 90-day 90-day catheterization PTCA Hospital type rate, % rate, To 1984 Never adopted catheterization Adopted catheterization, 1985-1990 Adopted catheterization by 1984 High volume 1990 Never adopted catheterization Adopted catheterization, 1985-1990 Adopted catheterization by 1984 High volume 90-day CABG rate, % 6.4 6.3 14.3 10.2 23.9 33.9 43.6 37.6 0.6 0.6 1.9 1.3 6.9 9.4 14.5 12.1 3.5 4.0 6.6 5.3 9.2 12.1 13.9 12.7 $11,371 $12,582 $12,616 $13,867 $14,564 $15,929 $13,656 $15,004 $14,953 $16,377 $17,019 $18,545 $18,325 $19,913 $17,582 $19,148 PTCA, percutaneous transluminal coronary angioplasty; CABG, coronary artery bypass graft surgery.
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From page 51... ...
Patients relatively near to hospitals performing catheterization are much more likely to be admitted to catheterization hospitals for AMI treatment, and they are significantly more likely to undergo catheterization in all years. Similarly, patients near to high-volume hospitals are much more likely to be admitted to high-volume hospitals, and consequently are significantly more likely to be treated by specialized medical staff, in a special-care care unit, and with other dimensions of higher-intensity care.
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From page 52... ...
The following rightclosed intervals were used to construct groups for differential distance to the intensive hospital types (high volume, adopted catheterization by 1984, adopted catheterization between 1985-1990)
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From page 53... ...
For example, hospitals that adopted catheterization early used the procedure much more often than all other hospital types: catheterization rates for patients initially treated at these hospitals were 5.7 percentage points higher than at noncatheterization hospitals in 1984, 11.3 percentage points higher in 1987, and 13.7 percentage points higher in 1990. Further, hospitals adopting catheterization showed the emergence of treatment patterns that rely more heavily on cardiac procedures.
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From page 54... ...
Moreover, the substantial improvements in AMI mortality since 1984 do not support the view that the payment reforms have adversely affected outcomes for elderly AMI patients. However, Medicare hospital reimbursement incentives are not high-powered in at least two important respects (1~.
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