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财务援助项目对医疗服务利用的影响:来自Kaiser Permanente的证据

The Impact of Financial Assistance Programs on Health Care Utilization: Evidence from Kaiser Permanente
AER: Insights · 2022 · Alyce Sophia Adams、Raymond Kluender、Neale Mahoney、Jinglin Wang、Francis Wong、Wesley Yin

中文摘要

大多数医院都设有面向低收入患者的财务援助项目。我们利用Kaiser Permanente的行政数据,研究财务援助对医疗服务利用的影响。基于确定项目参与资格的收入门槛,我们采用断点回归设计,发现财务援助使住院、门诊和急诊就诊的概率分别提高了3.6个百分点(59%)、13.4个百分点(20%)和6.7个百分点(53%),但这些效应在获得项目援助三个季度后消退。财务援助还促进了对治疗敏感的疾病的检出和管理(例如,使用治疗糖尿病的药物),这表明财务援助可能使患者获得更多高价值医疗服务。

Abstract

Most hospitals have financial assistance programs for low-income patients. We use administrative data from Kaiser Permanente to study the effects of financial assistance on healthcare utilization. Using a regression discontinuity design based on an income threshold for program eligibility, we find that financial assistance increases the likelihood of an inpatient, ambulatory and emergency department encounter by 3.6 pp (59%), 13.4 pp (20%), and 6.7 pp (53%), respectively, though effects dissipate three quarters after program receipt. Financial assistance also increases the detection and management of treatment-sensitive conditions (e.g., drugs treating diabetes), suggesting financial assistance may increase receipt of high-value care.
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