纵向一体化与高利润转诊的择肥而噬：医院自有专业护理机构的案例
Vertical Integration and Cream Skimming of Profitable Referrals: The Case of Hospital-Owned Skilled Nursing Facilities
American Economic Journal: Economic Policy · 2026 · David Cutler、Leemore Dafny、David C. Grabowski、Steven Lee、Christopher Ody
中文摘要
我们考察医院与专业护理机构（SNF）的纵向一体化是否会通过阻断竞争对手专业护理机构获取高利润转诊的渠道来削弱竞争。我们发现，这种情况确实可能发生：在一体化医疗服务提供者中，对于从上游医院出院的某位特定患者，其专业护理机构报销额每增加1%，该患者被自转诊至该医院下游专业护理机构的比例就会增加1.8%。我们没有发现患者和支付方获得抵消性收益的证据：这些增加的自转诊对患者结局和医疗保险（Medicare）支出的影响估计不精确，为零。（JEL G34, I11, I13, J14, L14, L22）
Abstract
We examine whether vertical integration of hospitals and skilled nursing facilities (SNFs) could lessen competition by foreclosing rival SNFs’ access to lucrative referrals. We find that it could: Among integrated providers, a 1 percent increase in SNF reimbursement for a given patient discharged from the upstream hospital increases the self-referral rate to the hospital’s downstream SNF(s) by 1.8 percent. We find no evidence of offsetting benefits for patients and payers: These increased self-referrals have an imprecisely estimated zero effect on patient outcomes and Medicare spending. (JEL G34, I11, I13, J14, L14, L22)