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Geographic Variation in the Health and Economic Determinants and Outcomes of Elective Surgery

a PSC Research Project

Investigators:   Lauren Nicholas, Kenneth M. Langa, John D. Birkmeyer

The value of high levels of healthcare spending and utilization in the United States is frequently questioned. Using Medicare claims data, researchers identify significant geographic variation in overall spending and use of discretionary/expensive services that are not associated with either life span or reports of greater overall satisfaction with care received. While more intensive healthcare utilization may not extend patients' lives, it may provide other important benefits for patient well-being, including improving functional status and productive engagement (e.g., working for pay, volunteering, and providing unpaid care to family members).

This study assesses the effect of elective surgery to treat four common chronic conditions – arthritis, back pain, cataracts and heart disease – on health and disability outcomes related to quality of life (mobility and depression), and on economic outcomes (paid and unpaid work). Longitudinal survey data from the Health and Retirement Study linked to respondents' Medicare claims and national Medicare data will facilitate a difference-in-differences approach to estimating a causal effect of surgery by comparing recipients to non-recipients over time. Geographic variation in practice patterns will allow comparisons of patients receiving surgery at different levels of disease severity. The results of this study will facilitate evidence-based policymaking by the Centers for Medicare and Medicaid Services and other payers, and make timely methodological contributions to the growing field of cost-effectiveness research. Patients, their families, and employers will be the ultimate beneficiaries of these findings as providers and payers can account for the effectiveness of healthcare interventions in preserving typically unmeasured aspects of health and productive engagement. This research will provide important information to policymakers implementing the Affordable Care Act and considering further changes to the Medicare program to address rising healthcare costs and the rapid growth of the over-65 population.

Public Health Relevance: This study will have immediate relevance for the Medicare program and for patients whose access to elective surgery may be changed by implementation of the Affordable Care Act. Findings about the health, functional status, and economic effects of several elective surgeries for older adults can be used for comparative effectiveness research and treatment guidelines. Results will also be important for the Social Security program, patients, and their families because changes in labor supply and informal care giving by older adults in response to changes in medical care availability will impact Social Security payroll taxes intake and payment of retirement and disability benefits.

Funding Period: 04/01/2012 to 08/31/2013

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