Norton Edward C, Van Houtven Courtney Harold, Lindrooth Richard C, Normand Sharon-Lise T, Dickey Barbara
Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, 27599-7411, USA.
Health Econ. 2002 Jul;11(5):377-87. doi: 10.1002/hec.675.
A change in payment mechanism for inpatient care from per diem to per episode creates two incentives - a marginal and an average price effect - to change length of stay. The decrease in marginal price per day to zero should reduce the length of stay, while an increase in average price per inpatient stay should increase the length of stay. This study uses data from a natural experiment to estimate both marginal and average price elasticities, and to test whether the length of stay falls after the introduction of prospective payment in a sample of 8509 severely mentally ill patients. We estimate that the marginal price elasticity is zero, but the average price elasticity is between 0.16 and 0.20. The results were generally robust for short- and long stayers, and for persons admitted early and late after the change in payment mechanism. The model controlled for hospital fixed effects and individual random effects.
住院护理支付机制从按日付费改为按病例付费会产生两种促使住院时长发生变化的激励因素——边际价格效应和平均价格效应。每日边际价格降至零应会缩短住院时长，而每次住院的平均价格上升则应会延长住院时长。本研究利用一项自然实验的数据来估计边际价格弹性和平均价格弹性，并检验在8509名重症精神病患者样本中引入前瞻性支付后住院时长是否会缩短。我们估计边际价格弹性为零，但平均价格弹性在0.16至0.20之间。对于住院时间短和长的患者，以及在支付机制改变后早入院和晚入院的患者，结果总体上都很稳健。该模型控制了医院固定效应和个体随机效应。
