Widener University.
J Health Polit Policy Law. 2010 Feb;35(1):95-126. doi: 10.1215/03616878-2009-042.
The Medicare prospective payment system (PPS) contains incentives for hospitals to improve efficiency by placing them at financial risk to earn a positive margin on services rendered to Medicare patients. Concerns about the financial viability of small rural hospitals led to the implementation of the Medicare Rural Hospital Flexibility Program (Flex Program) of 1997, which allows facilities designated as critical access hospitals (CAHs) to be paid on a reasonable cost basis for inpatient and outpatient services. This article compares the cost inefficiency of CAHs with that of nonconverting rural hospitals to contrast the performance of hospitals operating under the different payment systems. Stochastic frontier analysis (SFA) was used to estimate cost inefficiency. Analysis was performed on pooled time-series, cross-sectional data from thirty-four states for the period 1997-2004. Average estimated cost inefficiency was greater in CAHs (15.9 percent) than in nonconverting rural hospitals (10.3 percent). Further, there was a positive association between length of time in the CAH program and estimated cost inefficiency. CAHs exhibited poorer values for a number of proxy measures for efficiency, including expenses per admission and labor productivity (full-time-equivalent employees per outpatient-adjusted admission). Non-CAH rural hospitals had a stronger correlation between cost inefficiency and operating margin than CAH facilities did.
医疗保险预付制（PPS）通过将医院置于财务风险之中，激励其提高效率，使其为医疗保险患者提供的服务获得正的利润率。对小型农村医院的财务生存能力的担忧导致了 1997 年医疗保险农村医院灵活性计划（Flex 计划）的实施，该计划允许被指定为关键访问医院（CAH）的设施按合理成本为住院和门诊服务付费。本文将 CAH 的成本效率低下与非转换农村医院进行比较，以对比在不同支付制度下运营的医院的绩效。随机前沿分析（SFA）用于估计成本效率。对 1997 年至 2004 年期间 34 个州的汇总时间序列、横截面数据进行了分析。CAH（15.9%）的平均估计成本效率高于非转换农村医院（10.3%）。此外，在 CAH 计划中的时间长短与估计的成本效率之间存在正相关关系。CAH 在一些效率代理指标上表现不佳，包括每入院费用和劳动生产率（每门诊调整入院的全职等价员工）。非 CAH 农村医院的成本效率与营业利润率之间的相关性强于 CAH 设施。
