长期护理医院：一个关于浪费的案例研究

中文摘要

美国医疗保健领域存在大量浪费，但对于如何应对这一问题，鲜有共识。我们识别出一个浪费来源：长期护理医院（LTCHs）。我们采用事件研究设计，利用长期护理医院进入医院市场这一事件，发现大多数长期护理医院患者在反事实情况下本会在专业护理机构接受护理——这些机构提供的护理在医学上相似，但获得的支付显著较少——而转向长期护理医院接受护理，使患者在我们能够客观衡量的所有维度上要么未受影响，要么状况更差。我们的结果意味着，如果不允许患者出院后转至长期护理医院，美国联邦医疗保险（Medicare）每年可节省约46亿美元。

Abstract

Abstract There is substantial waste in U.S. healthcare but little consensus on how to combat it. We identify one source of waste: long-term care hospitals (LTCHs). Using the entry of LTCHs into hospital markets in an event study design, we find that most LTCH patients would have counterfactually received care at Skilled Nursing Facilities—facilities that provide medically similar care but are paid significantly less—and that substitution to LTCHs leaves patients unaffected or worse off on all dimensions we can objectively measure. Our results imply Medicare could save about $4.6 billion per year by not allowing discharge to LTCHs.