• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Journal of Economics & Management Strategy >How to regulate heterogeneous hospitals?
【24h】

How to regulate heterogeneous hospitals?

机译：如何规范异类医院？

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

In many areas of health care financing, there is controversy over the sources of cost variability and about the respective roles of inefficiency versus legitimate heterogeneity. This paper proposes a payment system that creates incentives to increase hospital efficiency when hospitals are heterogeneous, without reducing the quality of care. We consider an extension of Shleifer's yardstick competition model and apply an econometric approach to identify and evaluate observable and unobservable sources of cost heterogeneity. Moral hazard can be seen as the result of two components: long-term moral hazard (hospital management can be permanently inefficient) and transitory moral hazard. The latter is linked to the manager's transitory cost-reducing effort. For instance, he or she can be more or less rigorous each year when bargaining prices for supplies delivered to the hospital by outside firms. The use of a three-dimensional nested database makes it possible to identify transitory moral hazard and to estimate its effect on hospital cost variability. Econometric estimates are performed on a sample of 7,314 stays for acute myocardial infarction observed in 36 French public hospitals over the period 1994-1997. We obtain two alternative payment systems. The first takes all unobservable hospital heterogeneity into account, provided that it is time invariant, whereas the second ignores unobservable heterogeneity. Simulations show that substantial budget savings—at least 20%—can be expected from the implementation of such payment rules. The first method of payment has the great advantage of reimbursing high-quality care. It leads to substantial potential savings because it provides incentives to reduce costs linked to transitory moral hazard, whose influence on cost variability is far from negligible. This payment rule could be extended to other areas of health care financing, such as Adjusted Average Per Capita Cost to calculate Medicare Managed Care reimbursements in the United States.
机译：在医疗保健筹资的许多领域，关于成本可变性的来源以及效率低下与合法异质性的各自作用存在争议。本文提出了一种支付系统，该系统可以在医院异质的情况下激励提高医院的效率，同时又不会降低护理质量。我们考虑对Shleifer的标准竞争模型进行扩展，并应用计量经济学的方法来识别和评估成本异质性的可观察和不可观察的来源。道德风险可以看成是两个因素的结果：长期道德风险（医院管理可能永远无效）和暂时性道德风险。后者与经理的暂时性降低成本的努力有关。例如，在为外部公司交付给医院的物资进行议价时，他或她每年可能会严格一些。使用三维嵌套数据库可以识别短暂的道德风险并估算其对医院成本变化的影响。在1994年至1997年期间，对36家法国公立医院的7,314例急性心肌梗死住院病人进行了计量经济学估算。我们获得了两种替代的支付系统。第一个考虑了所有不可观察的医院异质性，条件是时间不变，而第二个则忽略了不可观察的异质性。模拟显示，通过实施此类付款规则，可以节省大量预算（至少20％）。第一种付款方式具有偿还高质量护理的巨大优势。它可以节省大量成本，因为它提供了减少与暂时性道德风险相关的成本的诱因，而瞬态道德风险对成本变异性的影响远远不能忽略。该付款规则可以扩展到医疗保健筹资的其他领域，例如调整后的人均费用，以计算美国的医疗保险管理式医疗报销。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号