The value of high levels of healthcare spending and utilization in the United States is frequently questioned. Using Medicare claims data, Dartmouth Atlas Project researchers identify significant geographic variation in overall spending and use of discretionary and expensive services though patients in higher spending regions do not live longer or report greater overall satisfaction with care received. While more intensive healthcare utilization may not extend patients'lives, there may be important and currently unappreciated consequences of additional treatments for multiple dimensions of patient well-being, including 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 including mobility and depression, and economic outcomes including 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. Beyond the scientific aims, this career development award will provide training in gerontology, medicine, and public health for a PhD-trained health economist. The skills obtained during the training period will enable the candidate to perform cutting-edge research at the intersection of economics, medicine, and gerontology to inform health policies towards older adults.

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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
1K01AG041763-01
Application #
8279531
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Haaga, John G
Project Start
2012-04-01
Project End
2017-03-31
Budget Start
2012-04-01
Budget End
2013-03-31
Support Year
1
Fiscal Year
2012
Total Cost
$124,470
Indirect Cost
$9,220
Name
University of Michigan Ann Arbor
Department
Biostatistics & Other Math Sci
Type
Organized Research Units
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Shih, Terry; Nicholas, Lauren H; Thumma, Jyothi R et al. (2014) Does pay-for-performance improve surgical outcomes? An evaluation of phase 2 of the Premier Hospital Quality Incentive Demonstration. Ann Surg 259:677-81
Sakshaug, Joseph W; Weir, David R; Nicholas, Lauren H (2014) Identifying diabetics in Medicare claims and survey data: implications for health services research. BMC Health Serv Res 14:150
Nicholas, Lauren H; Bynum, Julie P W; Iwashyna, Theodore J et al. (2014) Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia. Health Aff (Millwood) 33:667-74
Nicholas, Lauren Hersch; Dimick, Justin B (2013) Bariatric surgery in minority patients before and after implementation of a centers of excellence program. JAMA 310:1399-400
Dimick, Justin B; Nicholas, Lauren H; Ryan, Andrew M et al. (2013) Bariatric surgery complications before vs after implementation of a national policy restricting coverage to centers of excellence. JAMA 309:792-9
McInerney, Melissa; Mellor, Jennifer M; Nicholas, Lauren Hersch (2013) Recession depression: mental health effects of the 2008 stock market crash. J Health Econ 32:1090-104