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Hospital quality and Medicare payment: A theoretical and empirical investigation.

机译：医院质量和医疗保险支付：理论和实证研究。

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摘要

Does Medicare's payment rate for a hospital stay influence the quality of care received by a patient? We examine this question, theoretically and empirically. First, a model is developed which generates the key hypothesis---that Medicare's payment rate per admission should be positively related to care quality. We then test this hypothesis by estimating the relationship between Medicare's DRG payment for pneumonia, heart failure and heart attacks and care quality, using clinically-recognized measures of the quality of pneumonia care, heart failure care and heart attack care. Newly available data on acute hospitals in 2007 from "Hospital Compare" (maintained by CMS) are analyzed. Similar results are provided from pneumonia care and heart failure care. We find a significant positive relationship between Medicare's payment rate and care quality for some hospitals in both pneumonia care and heart failure care, but not for others, and where it is significant, the effect on quality is small in magnitude in both cares. For a hospital with average characteristics, the effect of payment on quality is insignificant. However, for hospitals that are very highly paid for pneumonia or heart failure and hospitals that treat large numbers of pneumonia cases or heart failure cases, we find a positive significant relationship. For such hospitals, which likely derive substantial revenue from pneumonia care or heart failure care, an increase in Medicare's payment rate leads to a very small improvement in the quality of care provided.
机译：医疗保险的住院费率是否会影响患者获得的护理质量？我们在理论上和经验上都研究了这个问题。首先，建立了一个模型，该模型产生了关键的假设-医疗保险的每次住院支付率应与护理质量呈正相关。然后，我们通过使用临床公认的肺炎护理，心力衰竭护理和心脏病发作护理质量衡量方法，通过估计Medicare肺炎，心力衰竭和心脏病发作与护理质量的DRG付款之间的关系，来检验该假设。分析了2007年“医院比较”（由CMS维护）中有关急诊医院的最新数据。肺炎护理和心力衰竭护理提供了类似的结果。我们发现，某些医院在肺炎护理和心力衰竭护理中，Medicare的支付率与护理质量之间存在显着的正相关关系，而对于其他医院而言，则不然，并且在有意义的情况下，两种护理对质量的影响均很小。对于具有一般特征的医院，付款对质量的影响微不足道。但是，对于肺炎或心力衰竭的高薪医院以及治疗大量肺炎或心力衰竭病例的医院，我们发现存在正相关关系。对于可能从肺炎护理或心力衰竭护理中获得可观收入的此类医院，医疗保险支付率的提高导致所提供护理质量的改善很小。

著录项

  • 作者

    Huang, Jinghua.;

  • 作者单位

    Wayne State University.;

  • 授予单位 Wayne State University.;
  • 学科 Health Sciences Aging.;Health Sciences Health Care Management.;Sociology Public and Social Welfare.;Economics General.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 102 p.
  • 总页数 102
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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