Sood Neeraj, Alpert Abby, Barnes Kayleigh, Huckfeldt Peter, Escarce José J
University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall (VPD), 2nd Floor, Los Angeles, CA 90089-3333, United States; National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138, United States.
The Wharton School, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, United States.
J Health Econ. 2017 Jan;51:66-83. doi: 10.1016/j.jhealeco.2016.12.006. Epub 2016 Dec 30.
Policymakers are increasingly interested in reducing healthcare costs and inefficiencies through innovative payment strategies. These strategies may have heterogeneous impacts across geographic areas, potentially reducing or exacerbating geographic variation in healthcare spending. In this paper, we exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, we find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets. This led to a convergence in spending across geographic areas. We find that much of the reduction in provider costs is driven by greater exit of "high-cost" providers in more competitive markets.
政策制定者越来越有兴趣通过创新支付策略来降低医疗成本和提高效率。这些策略可能会在不同地理区域产生不同的影响，有可能减少或加剧医疗支出的地理差异。在本文中，我们利用一项针对家庭医疗保健的重大支付改革，来研究报销费用的降低是否会根据市场竞争程度导致治疗强度和供应商成本的差异变化。利用医疗保险理赔数据，我们发现，虽然在改革前，竞争更激烈市场中的供应商平均成本更高，但与竞争较弱的市场相比，这些市场在改革后治疗强度和成本的降幅比例更大。这导致了不同地理区域的支出趋于一致。我们发现，供应商成本的大幅降低很大程度上是由竞争更激烈市场中“高成本”供应商的大量退出所推动的。
