American Economic Review · 2024 · Jonathan Gruber、David H. Howard、Jetson Leder‐Luis、Theodore L. Caputi
中文摘要
Medicare临终关怀计划旨在为终末期患者提供姑息治疗，但长期入住临终关怀机构的患者利润丰厚，这引发了对快速增长的营利性部门中阿尔茨海默病及相关痴呆症（ADRD）人群过度使用的担忧。我们利用20年间营利性临终关怀机构的进入，首次对营利性临终关怀对患者支出的影响提供了因果估计。我们发现，临终关怀通过抵消ADRD患者的其他昂贵护理费用，为Medicare节省了资金。因此，包括收入上限和反欺诈诉讼在内的限制临终关怀使用的政策具有扭曲性，并阻碍了可能节省成本的入院。(JEL H51, I11, I12, I18, J14, L84)
Abstract
The Medicare hospice program is intended to provide palliative care to terminal patients, but patients with long stays in hospice are highly profitable, motivating concerns about overuse among the Alzheimer's and Dementia (ADRD) population in the rapidly growing for-profit sector. We provide the first causal estimates of the effect of for-profit hospice on patient spending using the entry of for-profit hospices over 20 years. We find hospice has saved money for Medicare by offsetting other expensive care among ADRD patients. As a result, policies limiting hospice use including revenue caps and antifraud lawsuits are distortionary and deter potentially cost-saving admissions. (JEL H51, I11, I12, I18, J14, L84)