退伍军人事务部医疗服务是否具有优势？来自双重参保退伍军人的证据

中文摘要

我们研究面向65岁及以上退伍军人的医疗服务由公共部门提供还是私人部门提供；这些退伍军人既可接受美国退伍军人事务部（VA）提供的医疗服务，也可在由联邦医疗保险（Medicare）支付费用的私立医院接受治疗。利用Doyle等人（2015）的救护车研究设计，我们发现VA将28天死亡率降低了46%（4.5个百分点），且这些生存收益具有持续性。VA还将28天医疗支出降低了21%，并且相较于私立医院，其报告的服务构成存在显著差异。我们发现了一些提示性证据，表明医疗连续性、卫生信息技术与整合型医疗之间存在互补性。

Abstract

We study public versus private provision of health care for veterans aged 65 and older who may receive care provided by the US Department of Veterans Affairs (VA) and in private hospitals financed by Medicare. Utilizing the ambulance design of Doyle et al. (2015), we find that the VA reduces 28-day mortality by 46 percent (4.5 percentage points) and that these survival gains are persistent. The VA also reduces 28-day spending by 21 percent and delivers strikingly different reported services relative to private hospitals. We find suggestive evidence of complementarities between continuity of care, health IT, and integrated care.