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Center for Health Services and Outcomes Research

Innovative Methods: New Applications

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

The value of high levels of healthcare spending and utilization in the United States is frequently questioned 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 facilitate estimating a causal effect of surgery by comparing recipients to non-recipients over time. Geographic variation in practice patterns allows 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.