关键词：
Health Sciences
Health Care Management
摘要：
These essays investigate three aspects regarding the efficacy of medical service delivery and payment. They expand on the broad areas of preventive versus emergency care, physician incentives, and a relatively new type of facility—ambulatory surgical centers (ASCs). The first chapter of this dissertation examines screening for colorectal cancer—the leading cause of cancer deaths after lung cancer. Using a regression discontinuity design, it investigates how public policy emphasis and coverage expansion by insurance institutions in recent years have impacted screening utilization. It examines differences between African Americans and Caucasians, since there are large disparities in colorectal cancer incidence and death between these two groups. To evaluate the increase in screening utilization, Markov cohort simulations are used to predict how changes in screening with colonoscopies affect the expected years of survival, colorectal cancer deaths, and costs. The data suggest that policy encouragement to screen at age 50 increased screening rates more than twofold for both African Americans and Caucasians. Simulations indicate that had the people who received screenings in 1997 in fact screened as often as those in 2004 did, life expectancy would have increased by roughly 0.02% to 0.66%, depending on age. Additionally, the increase in screening was highly cost-effective for those below 70 years old. The second chapter of this dissertation examines a particular type of physician incentive—physician board membership of medical facilities. Through recommendations and referrals, physicians influence the distribution of not only the population seeking care, but also the allocation of patients among different players in the medical care industry, such as: insurance companies, medical facilities, and pharmaceutical companies. Understanding physician relationships with these players and potential conflicts of interests is becoming increasingly important as health care costs ri
欢迎来到三峡大学图书馆！
