医疗保健行业准入监管的影响：以家庭健康护理为例。
The Effect of Entry Regulation in the Health Care Sector: the Case of Home Health.
作者信息
Polsky Daniel, David Guy, Yang Jianing, Kinosian Bruce, Werner Rachel
机构信息
University of Pennsylvania, Division of General Internal Medicine, Blockley Hall, Rm. 1204, 423 Guardian Drive, Philadelphia, PA 19104.
University of Pennsylvania, the Wharton School, 202 Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA, 19104 (215) 573-5780 - Office, Philadelphia, PA 19104,
出版信息
J Public Econ. 2014 Feb 1;110:1-14. doi: 10.1016/j.jpubeco.2013.11.003.
The consequences of government regulation in the post-acute care sector are not well understood. We examine the effect of entry regulation on quality of care in home health care by analyzing the universe of hospital discharges during 2006 for publicly insured beneficiaries (about 4.5 million) and subsequent home health admissions to determine whether there is a significant difference in home health utilization, hospital readmission rates, and health care expenditures in states with and without Certificate of Need laws (CON) regulating entry. We identify these effects by looking across regulated and nonregulated states within Hospital Referral Regions, which characterize well-defined health care markets and frequently cross state boundaries. We find that CON states use home health less frequently, but system-wide rehospitalization rates, overall Medicare expenditures, and home health practice patterns are similar. Removing CON for home health would have negligible system-wide effects on health care costs and quality.
政府对急性后期护理部门的监管所产生的后果尚未得到充分理解。我们通过分析2006年期间公共保险受益人群（约450万）的全部医院出院情况以及随后的家庭健康护理入院情况，来研究准入监管对家庭健康护理质量的影响，以确定在有和没有需求证明法律（CON）来监管准入的州，家庭健康护理的使用、医院再入院率以及医疗保健支出是否存在显著差异。我们通过观察医院转诊区域内受监管和不受监管的州来确定这些影响，医院转诊区域界定了明确的医疗保健市场，且经常跨越州界。我们发现，有需求证明法律的州使用家庭健康护理的频率较低，但全系统的再住院率、医疗保险总支出以及家庭健康护理的实践模式是相似的。取消家庭健康护理的需求证明法律对医疗保健成本和质量的全系统影响可以忽略不计。
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