利润涡轮？医疗保健中的合同博弈与收入分配
Turbocharging Profits? Contract Gaming and Revenue Allocation in Healthcare
American Economic Journal: Applied Economics · 2024 · [{"name": "Atul Gupta", "affiliation": ["National Bureau of Economic Research", "Cornell University", "Columbia University", "University of California, Berkeley"]}, {"name": "Ambar La Forgia", "affiliation": ["National Bureau of Economic Research", "Cornell University", "Columbia University", "University of California, Berkeley"]}, {"name": "Adam Sacarny", "affiliation": ["National Bureau of Economic Research", "Cornell University", "Columbia University", "University of California, Berkeley"]}]
中文摘要
企业常常利用政府合同中的漏洞来增加收入，但对于它们如何配置这些资金，人们知之甚少。我们研究了医院如何配置通过操纵 Medicare（联邦医疗保险）漏洞而获得的 30 亿美元。平均而言，参与操纵的医院使其 Medicare 收入和总收入增加了约 10%，这意味着对其他支付方产生了较大的溢出效应。非营利医院将大部分资金用于运营成本；营利性医院——受一家大型连锁机构主导——则将资金从资产负债表中剥离，分配给高管和股东。相应地，我们仅在非营利医院检测到死亡率下降。我们的结果表明，人为设计的意外收益所带来的后果因医院所有权性质而存在显著差异。（JEL D86, H51, I11, I12, I18, L31）
Abstract
Firms often exploit weaknesses in government contracts to boost revenues, yet little is known about how they allocate these funds. We study how hospitals allocated $3 billion obtained from gaming a Medicare loophole. The average gaming hospital increased Medicare and total revenue by around 10 percent, implying large spillovers on other payers. Nonprofit hospitals deployed most funds toward operating costs. For-profits—driven by a large chain—deducted funds off their balance sheets, distributing them to executives and shareholders. Accordingly, we detect reductions in mortality only at nonprofits. Our results imply that the consequences of engineered windfalls vary substantially by hospital ownership. (JEL D86, H51, I11, I12, I18, L31)