Frank Matthew B, Hsu John, Landrum Mary Beth, Chernew Michael E
Harvard Law School, Harvard University, Graduate School of Arts and Sciences, Program in Health Policy, Cambridge, MA.
Program for Clinical Economics and Policy Analysis, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.
Health Serv Res. 2015 Oct;50(5):1628-48. doi: 10.1111/1475-6773.12291. Epub 2015 Mar 9.
To evaluate the effect of a tiered network on hospital choice for scheduled admissions.
The 2009-2012 patient-level claims data from Blue Cross Blue Shield of Massachusetts (BCBSMA).
BCBSMA's three-tiered hospital network employs large differential cost sharing to encourage patients to seek care at hospitals on the preferred tier. During the study period, 44 percent of hospitals were moved to a different tier based on changes in cost or quality performance. We relied on this longitudinal variation for identification and specified conditional logit models to estimate the effect of the tiered network (TN) on patients' hospital choices relative to a non-TN comparison group.
The TN was associated with increased use of hospitals on the preferred and middle tiers relative to the nonpreferred tier for planned admissions. The results suggest that if all members were in a TN plan, relative to all members being in a non-TN plan, scheduled admissions to hospitals on the nonpreferred tier would drop by 7.6 percentage points, while those to middle and preferred tier hospitals would rise by 0.9 and 6.6 percentage points, respectively.
Differential cost sharing can steer patients toward preferred hospitals for planned admissions.
评估分层网络对择期住院患者医院选择的影响。
来自马萨诸塞州蓝十字蓝盾（BCBSMA）2009 - 2012年患者层面的理赔数据。
BCBSMA的三层医院网络采用大幅差异化成本分担方式，鼓励患者前往首选层级的医院就医。在研究期间，44%的医院因成本或质量表现的变化而被调整到不同层级。我们依靠这种纵向变化进行识别，并指定条件logit模型来估计分层网络（TN）相对于非TN对照组对患者医院选择的影响。
与非首选层级相比，TN与计划住院时首选和中间层级医院的使用增加有关。结果表明，如果所有成员都参加TN计划，相对于所有成员都参加非TN计划，非首选层级医院的择期住院率将下降7.6个百分点，而中间层级和首选层级医院的择期住院率将分别上升0.9个和6.6个百分点。
差异化成本分担可以引导患者选择首选医院进行择期住院。
