Columbia University Mailman School of Public Health, New York, NY, United States; NBER, United States.
J Health Econ. 2018 Jul;60:142-164. doi: 10.1016/j.jhealeco.2018.06.005. Epub 2018 Jun 19.
Performance-raising practices tend to diffuse slowly in the health care sector. To understand how incentives drive adoption, I study a practice that generates revenue for hospitals: submitting detailed documentation about patients. After a 2008 reform, hospitals could raise their Medicare revenue over 2% by always specifying a patient's type of heart failure. Hospitals only captured around half of this revenue, indicating that large frictions impeded takeup. Exploiting the fact that many doctors practice at multiple hospitals, I find that four-fifths of the dispersion in adoption reflects differences in the ability of hospitals to extract documentation from physicians. A hospital's adoption of coding is robustly correlated with its heart attack survival rate and its use of inexpensive survival-raising care. Hospital-physician integration and electronic medical records are also associated with adoption. These findings highlight the potential for institution-level frictions, including agency conflicts, to explain variations in health care performance across providers.
提效实践在医疗保健领域往往传播缓慢。为了了解激励措施如何推动采用，我研究了一种为医院带来收入的实践：详细记录患者信息。在 2008 年的改革后，医院通过始终指定患者心力衰竭类型，可将其医疗保险收入提高超过 2%。然而，医院仅获得了约一半的收入，表明存在较大的摩擦阻碍了采用。利用许多医生在多家医院执业的事实，我发现，采用率的五分之四差异反映了医院从医生那里提取文件的能力差异。医院采用编码与心脏病发作存活率以及使用廉价提高生存率的护理密切相关。医院-医生整合和电子病历也与采用相关。这些发现强调了机构层面摩擦（包括代理冲突）的潜力，可以解释不同提供者之间的医疗保健绩效差异。
