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首页> 外文期刊>Journal of health economics >The effect of prospective payment on admission and treatment policy: Evidence from inpatient rehabilitation facilities
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The effect of prospective payment on admission and treatment policy: Evidence from inpatient rehabilitation facilities

机译：预期付款对入院和治疗政策的影响：来自住院康复设施的证据

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摘要

We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the number of patients admitted, admitting different types of patients, or changing the intensity of care. We use Medicare claims data to separately estimate each type of provider response. We also examine changes in patient outcomes and spillover effects on other post-acute care providers. We find that costs of care initially fell following the PPS, which we attribute to changes in treatment decisions rather than the characteristics of patients admitted to IRFs within the diagnostic categories we examine. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects in other post-acute settings and negative health impacts for only one of three diagnostic groups studied.
机译：我们检查了医疗服务提供者对Medicare住院康复设施（IRF）预期付款系统（PPS）的反应，该系统同时减少了边际报销和平均报销。 IRF可以通过更改入院患者的人数，接纳不同类型的患者或更改护理强度来对PPS做出反应。我们使用Medicare索赔数据单独估算每种类型的提供者响应。我们还将检查患者结局的变化以及对其他急性后护理提供者的溢出影响。我们发现护理费用最初是在PPS之后下降的，这归因于治疗决策的变化，而不是我们所检查的诊断类别中接受IRF治疗的患者的特征。但是，由于提供者的接纳政策的扩大，在PPS之后接纳IRF的可能性增加了。我们发现在其他急性后环境中仅有适度的外溢效应，并且仅对所研究的三个诊断组之一发现了负面的健康影响。

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  • 来源
    《Journal of health economics》 |2013年第5期|965-979|共15页
  • 作者

    Neeraj Sood; Peter J. Huckfeldt; David C. Grabowski; Joseph P. Newhouse; Jose J. Escarce;

  • 作者单位

    University of Southern California, 3335 S. Figueroa St., Unit A, University Park Campus, UGW-UnitA, Los Angeles, California, 90089-7273, United States,RAND Corporation, Santa Monica, CA, United States,National Bureau of Economic Research (NBER), Cambridge, MA, United States;

    RAND Corporation, Santa Monica, CA, United States;

    National Bureau of Economic Research (NBER), Cambridge, MA, United States,Harvard University, Boston, MA United States;

    National Bureau of Economic Research (NBER), Cambridge, MA, United States,Harvard University, Boston, MA United States;

    RAND Corporation, Santa Monica, CA, United States,National Bureau of Economic Research (NBER), Cambridge, MA, United States,University of California Los Angeles, Los Angeles, CA, United States;

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  • 正文语种 eng
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  • 关键词

    Medicare; Selection; Cream skimming; Mortality; Prospective payment;

    机译：医疗保险;选择;脱脂奶油;死亡;预期付款;

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