生产健康: 测量养老院的价值增值
Producing Health: Measuring Value Added of Nursing Homes
Econometrica · 2025 · [{"name": "Liran Einav", "affiliation": ["Stanford University"]}, {"name": "Amy Finkelstein", "affiliation": []}, {"name": "Neale Mahoney", "affiliation": ["Stanford University"]}]
中文摘要
我们构建了一个程式化(简化)模型, 用以估计护理院("SNFs")的增值指标, 该指标同时考虑了患者进入和离开护理院两端的选择性。我们将该模型与2011年至2016年间约600万名Medicare护理院患者身心健康的详细数据相结合, 估计了约14,000家不同护理院的增值。我们记录了增值方面存在显著异质性。在全国范围内, 与处于第10百分位的护理院相比, 处于第90百分位的护理院能够在患者健康水平相同的情况下使其提前近一周出院, 相当于中位住院时长的四分之一。市场内部的增值异质性几乎与全国范围内一样大。我们的结果表明, 通过鼓励患者在其市场内重新配置到更高质量护理院的政策, 有望获得可观收益。
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.