University of Southern California (USC), Los Angeles, CA, United States; RAND Corporation, Santa Monica, CA, United States; National Bureau of Economic Research (NBER), Cambridge, MA, United States.
J Health Econ. 2013 Sep;32(5):965-79. doi: 10.1016/j.jhealeco.2013.05.003. Epub 2013 Jul 2.
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.
我们考察了医疗服务提供者对医疗保险住院康复机构（IRF）前瞻性支付系统（PPS）的反应，该系统同时降低了边际报销额并提高了平均报销额。IRF 可以通过改变入院患者数量、收治不同类型的患者或改变护理强度来应对 PPS。我们使用医疗保险索赔数据分别估计每种类型的提供者反应。我们还考察了患者结果的变化以及对其他急性后护理提供者的溢出效应。我们发现，PPS 之后医疗费用最初下降，我们将其归因于治疗决策的变化，而不是我们在研究的诊断类别内收治的 IRF 患者的特征。然而，由于提供者扩大了收治政策，IRF 的收治概率在 PPS 之后增加。我们发现，在其他急性后环境中存在适度的溢出效应，并且仅在三个研究诊断组中的一个组中存在负面健康影响。
