The Impact of Market Structure on Oncology Care Public Deposited

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Last Modified
  • March 20, 2019
Creator
  • Winn, Aaron
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • The market structure of oncology care is undergoing dramatic consolidation. Little work has examined how market structure impacts oncology care. This study has three objectives: (1) investigate the effect of market structure on geographic access to care for patients receiving infused chemotherapy; (2) investigate the impact of market structure on Medicare reimbursement for patients receiving infused chemotherapy; and (3) evaluate how the market structure impacts the speed of diffusion in the use of new high- and low-value treatments for patients. Using a 20% sample of Medicare Fee-For-Service claims from 2008 to 2014, we identified a cohort of 142,770 patients receiving infused chemotherapy for cancer and 89,096 new users of chemotherapy. We assessed relationships between 1) competition and the number of chemotherapy-administering physicians within 25, 50, and 75 miles of the patient’s zip code and the distance traveled to receive chemotherapy, 2) competition and Medicare expenditures for infused chemotherapy, and 3) competition and diffusion of new treatments. We find that a one standard deviation increase in logged Herfindahl-Hirschman Index (HHI) (i.e., market becoming less competitive) increases the average distance traveled from 100 to 112 miles and decreases the average number of physicians within 75 miles from 346 to 312 physicians. When examining spending, we find that spending decreases as markets become less competitive at the claim service-line level and the day level but is not impacted when looking at total spending in the six months following treatment initiation. Finally, we examined five newly approved medications or existing medications with new indications: (nab-paclitaxel, bendamustine, degarelix, temsiroliimus, and bevacizumab) and find that the impact of competition on the diffusion of a new treatment varies by treatment. Nab-paclitaxel, a lower value drug, diffuses slower as markets become less competitive, whereas bendamustine, a higher value drug, diffuses faster as markets become less competitive. We do not find significant associations between market competition and drug diffusion for the other drugs studied. Competition impacts patients’ geographic access to care. The association between competition and healthcare spending and diffusion of medications is not consistent. Future research should examine how competition impacts patients’ access to care in other clinical areas, drivers for increased spending in consolidated areas, and the quality of care is impacted by competition for cancer patients.
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Rights statement
  • In Copyright
Advisor
  • Basch, Ethan
  • Trogdon, Justin
  • Holmes, George M.
  • Keating, Nancy
  • Dusetzina, Stacie
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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