Kessler 9709612 This research will investigate empirically the impact of legal an regulatory policy and physician decision making and the consequences of law-induced changes in health care decision for health care costs and patient health care outcomes. To date, none of the methods used the in the published literature have been based on datasets that would allow direct measurement of all of the key variables hypothesized to have causal relations among the law, physician and patient treatment decisions, health care costs, and health outcomes. Three studies will remedy this problem. The first project estimates the impact of medical malpractice liability law reforms on defensive medicine. It explores the why and how doctors practice defensive medicine. The second estimates the impact of living wills on medical treatment, costs, and outcomes at the end of life. The third estimates the impact of hospital competition on the cost and quality of medical care. Three types of data will be used. Medicare Part A and Part B claims forms and matching Social Security death date records have been linked in analytic files. Information regarding covered services, discharge information, and demographic informant are included. In addition, an ongoing project on Treatment Intensity and Outcomes of major illness data set guides the living will subproject. The longitudinal files span 1984-1993 and are updated regularly. The analyses will use data from 100 percent of Medicare beneficiaries who have ever had a particular illness will use 20% random sample of other beneficiaries as a comparison group. Medstat data will provide information on claims records for over 4 million nonelderly employees, dependents, and retirees with firm medical plans. National hospital information datasets will be used as well. %%% This research will investigate empirically the impact of legal an regulatory policy and physician decision making and the consequences of law-induced changes in health care decision for health care costs and patient health care outcomes. To date, none of the methods used the in the published literature have been based on datasets that would allow direct measurement of all of the key variables hypothesized to have causal relations among the law, physician and patient treatment decisions, health care costs, and health outcomes. Three studies will remedy this problem. The first project estimates the impact of medical malpractice liability law reforms on defensive medicine. It explores the why and how doctors practice defensive medicine. The second estimates the impact of living wills on medical treatment, costs, and outcomes at the end of life. The third estimates the impact of hospital competition on the cost and quality of medical care. Three types of data will be used. Medicare Part A and Part B claims forms and matching Social Security death date records have been linked in analytic files. Information regarding covered services, discharge information, and demographic informant are included. In addition, an ongoing project on Treatment Intensity and Outcomes of major illness data set guides the living will subproject. The longitudinal files span 1984-1993 and are updated regularly. The analyses will use data from 100 percent of Medicare beneficiaries who have ever had a particular illness will use 20% random sample of other beneficiaries as a comparison group. Medstat data will provide information on claims records for over 4 million nonelderly employees, dependents, and retirees with firm medical plans. National hospital information datasets will be used as well. ***
