受监管收入与医院行为:来自医疗保险制度改革的证据
Regulated Revenues and Hospital Behavior: Evidence from a Medicare Overhaul
Review of Economics and Statistics · 2022 · [{"name": "Tal Gross", "affiliation": ["Boston University", "Quest University Canada"]}, {"name": "Adam Sacarny", "affiliation": ["Columbia University"]}, {"name": "Maggie Shi", "affiliation": ["University of Chicago", "Columbia University"]}, {"name": "David Silver", "affiliation": ["University of California, Santa Barbara", "Princeton University"]}]
中文摘要
摘要：本文研究了2008年一项政策改革，Medicare在该改革中修订了医院支付制度，以更好地反映患者的疾病严重程度。我们构建了一个模拟工具变量，利用改革前患者数据与改革后规则，预测医院因政策变化而产生的报销变动。该改革导致各医院的Medicare支付率发生了大幅且持续的变化。面临更大Medicare报销增幅的医院，其收治的Medicare患者数量随之增加。估计结果表明，数量弹性为1.2。为应对患者数量的增加，医院增加了护士雇用，但同时也缩短了住院时长。
Abstract
Abstract We study a 2008 policy reform in which Medicare revised its hospital payment system to better reflect patients’ severity of illness. We construct a simulated instrument that predicts a hospital’s policy-induced change in reimbursement using pre-reform patients and postreform rules. The reform led to large persistent changes in Medicare payment rates across hospitals. Hospitals that faced larger gains in Medicare reimbursement increased the volume of Medicare patients they treated. The estimates imply a volume elasticity of 1.2. To accommodate greater volume, hospitals increased nurse employment, but also lowered length of stay.