The Effect of Healthcare Provider Availability on Spine Spending
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University of Michigan Medical School, Ann Arbor, MI, USA; 2Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; 3Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA; 4Department of Internal Medicine, Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; 5Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
BACKGROUND: Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that healthcare utilization and spending are driven by provider availability, which varies geographically and is a topic of healthcare policy debate. OBJECTIVE: To estimate the effect of provider availability on spine spending. DESIGN: Retrospective cohort study using relocation as a natural experiment. PARTICIPANTS: Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. MAIN MEASURES: We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of healthcare providers (primary care physicians, spine surgeons, and chiropractors) affected annual perbeneficiary spine spending. We evaluated increases and decreases in provider availability separately. To account for the relative sizes of the provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. KEY RESULTS: The association between provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. CONCLUSIONS: Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect healthcare spending.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06191-5) contains supplementary material, which is available to authorized users. Received March 31, 2020 Accepted August 27, 2020
KEY WORDS: provider availability; physician workforce; healthcare spending; back pain. J Gen Intern Med DOI: 10.1007/s11606-020-06191-5 © Society of General Internal Medicine 2020
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