Pletscher Mark
Institute of Economic Research, University of Neuchâtel, Rue A.-L. Breguet 2, Neuchâtel, 2000, Switzerland.
Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, Winterthur, 8400, Switzerland.
Eur J Health Econ. 2016 Sep;17(7):897-910. doi: 10.1007/s10198-015-0735-4. Epub 2015 Oct 7.
This study examines the changes in marginal revenue during psychiatric inpatient stays in a large Swiss psychiatric hospital after the introduction of a mixed reimbursement system with tariff rates that vary over length of stay. A discrete time duration model with a difference-in-difference specification and time-varying coefficients is estimated to assess variations in policy effects over length of stay. Among patients whose costs are fully reimbursed by the mixed scheme, the model demonstrates a significant effect of marginal revenue on length of stay. No significant policy effects are found among patients for whom only health insurance rates are delivered as mixed tariffs and government contributions are made retrospectively. The results indicate that marginal revenue can affect length of stay in inpatient psychiatry facilities, but that the reduction in marginal revenue must be sufficiently large.
本研究考察了在瑞士一家大型精神病医院引入混合报销系统后，精神科住院期间边际收益的变化情况，该系统的费率随住院时长而变化。我们估计了一个具有差分-差分设定和时变系数的离散时间持续模型，以评估政策效应在住院时长上的变化。在成本由混合方案全额报销的患者中，该模型显示边际收益对住院时长有显著影响。在那些仅以混合费率提供医疗保险费率且政府补贴为追溯性支付的患者中，未发现显著的政策效应。结果表明，边际收益会影响精神病住院设施的住院时长，但边际收益的降低必须足够大。
