纵向一体化与有利可图转诊的撇脂行为：以医院自有专业护理机构为例
Vertical Integration and Cream Skimming of Profitable Referrals: The Case of Hospital-Owned Skilled Nursing Facilities
American Economic Journal: Economic Policy · 2026 · [{"name": "David Cutler", "affiliation": ["Dana-Farber/Harvard Cancer Center"]}, {"name": "Leemore Dafny", "affiliation": ["Dana-Farber/Harvard Cancer Center"]}, {"name": "David C. Grabowski", "affiliation": ["Harvard University"]}, {"name": "Steven Lee", "affiliation": ["John Brown University"]}, {"name": "Christopher Ody", "affiliation": ["Kellogg's (Canada)"]}]
中文摘要
我们考察医院与专业护理机构（SNF）的纵向整合是否会通过阻断竞争对手 SNF 获得有利可图的转诊而削弱竞争。我们发现确有可能：在整合型服务提供者中，对于从上游医院出院的特定患者，其 SNF 报销每增加 1%，向该医院下游 SNF 的自我转诊率便提高 1.8%。我们没有发现患者与支付方获得抵消性收益的证据：这些增加的自我转诊对患者结局和 Medicare 支出的影响估计为不精确的零效应。（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)