Department of Economics, Swarthmore College, Swarthmore, Pennsylvania.
Department of Economics, William & Mary, Williamsburg, Virginia.
Health Econ. 2020 Jun;29(6):655-670. doi: 10.1002/hec.4009. Epub 2020 Feb 8.
Skilled nursing facility (SNF) spending has been one of the fastest growing categories of Medicare spending over the past few decades, and reductions in SNF payments are often recommended as part of Medicare cost containment efforts. Using a quasi-experiment resulting from a policy-driven and facility-specific Medicare payment change, we provide new evidence on how Medicare payment changes affect the amount of SNF care provided to Medicare patients. Specifically, we examine a one-time, plausibly exogenous change in the hospital wage index, an area-level adjustment to SNF payments that affected the majority of SNFs nationwide. Using a panel dataset of SNFs, we model the effects of these payment changes on more than 12,000 SNFs across the United States. We find that increases in Medicare payment rates to SNFs increased the total number of Medicare resident days at SNFs. Specifically, a 5% payment increase raised Medicare resident days by 2.33% at facilities with a 10% Medicare share relative to 0%. Further, the effects were asymmetric: Although Medicare payment increases affected Medicare days, payment decreases did not. Our results have important implications for policies that alter the Medicare base payment rates to SNFs and other health care providers.
专业护理机构（SNF）的支出是过去几十年中医疗保险支出增长最快的类别之一，因此经常建议减少 SNF 的支付作为医疗保险成本控制措施的一部分。我们利用一项由政策驱动和机构特定的医疗保险支付变化带来的准实验，提供了有关医疗保险支付变化如何影响向 Medicare 患者提供的 SNF 护理量的新证据。具体来说，我们研究了医院工资指数的一次性、合理外生变化，这是对全国大多数 SNF 进行的区域调整。我们使用 SNF 的面板数据集，对这些支付变化对美国各地 12000 多家 SNF 的影响进行建模。我们发现，向 SNF 支付的 Medicare 支付率增加会增加 SNF 中 Medicare 居民的总天数。具体来说，与 0%相比，支付增加 5%会使 Medicare 居民的天数增加 2.33%，在 Medicare 份额为 10%的机构中。此外，这种影响是不对称的：尽管 Medicare 支付增加会影响 Medicare 天数，但支付减少不会。我们的研究结果对于改变 SNF 和其他医疗保健提供者的 Medicare 基本支付率的政策具有重要意义。
