中文摘要
我们构建了一个简化模型，用以估算疗养院（SNF）的价值增值指标，该指标考虑了患者进入和离开疗养院时的选择性。我们利用该模型，结合2011年至2016年间约600万名美国联邦医疗保险（Medicare）疗养院患者身心健康状况的详细数据，估算了约14,000家不同疗养院的价值增值。我们发现，价值增值存在巨大的异质性。在全国范围内，与第10百分位的疗养院相比，第90百分位的疗养院能够使患者在几乎提前一周的时间内以相同的健康水平出院，相当于中位住院时长的四分之一。同一市场内部价值增值的异质性，几乎与全国范围内的异质性一样大。我们的研究结果表明，通过鼓励患者在其所在市场内转向更高质量的疗养院，相关政策有可能带来可观收益。
Abstract
We develop a stylized model that allows us to estimate a value-added measure for nursing homes ("SNFs") which accounts for patient selection both into and out of a SNF. We use the model, together with detailed data on the physical and mental health of about 6 million Medicare SNF patients between 2011 and 2016, to estimate the value added for about 14,000 distinct SNFs. We document substantial heterogeneity in value added. Nationwide, compared to a 10th percentile SNF, a 90th percentile SNF is able to discharge a patient at the same health level almost a week sooner, or one quarter of the median length of stay. Heterogeneity in value added within a market is almost as large as it is nationwide. Our results point to the potential for substantial gains through policies that encourage reallocation of patients to higher-quality SNFs within their market.