Department of Economics, College of William and Mary, Williamsburg, VA.
Health Serv Res. 2013 Oct;48(5):1593-616. doi: 10.1111/1475-6773.12069. Epub 2013 May 23.
To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting.
DATA SOURCES/STUDY SETTING: Hospital inpatient and outpatient discharge files from the Florida Agency for Health Care Administration from 1997 through 2008.
This study focuses on inguinal hernia repair surgery, one of the most commonly performed surgical procedures in the United States. We estimate multivariate regressions of inguinal hernia surgery counts in the outpatient setting and in the inpatient setting. The key explanatory variable is the time-varying Medicare payment rate specific to the procedure and hospital. Control variables include time-varying hospital and county characteristics and hospital and year-fixed effects.
Outpatient hernia surgeries fell in response to OPPS-induced rate cuts. The volume of inpatient hernia repair surgeries did not increase in response to reductions in the outpatient reimbursement rate.
Potential substitution from the outpatient setting to the inpatient setting does not pose a serious threat to Medicare's efforts to contain hospital outpatient costs.
考察医疗保险（Medicare）门诊按项目付费制（Outpatient Prospective Payment System，OPPS）下的门诊支付费率下降是否导致门诊服务向住院服务转移。
数据来源/研究地点：佛罗里达州卫生保健管理局（Florida Agency for Health Care Administration）1997 年至 2008 年的医院门诊和住院患者出院记录。
本研究集中于腹股沟疝修补术，这是美国最常施行的手术之一。我们对门诊和住院环境下的腹股沟疝手术数量进行了多元回归估计。关键的解释变量是特定于手术和医院的 Medicare 支付费率的时变变量。控制变量包括时变的医院和县特征以及医院和年度固定效应。
OPPS 导致的费率下降导致门诊疝手术数量下降。住院疝修补术数量并未因门诊报销费率下降而增加。
从门诊环境向住院环境的潜在替代对 Medicare 控制医院门诊成本的努力构不成严重威胁。
