医疗需求证明与家庭医疗市场竞争成本。
Certificate of need and the cost of competition in home healthcare markets.
机构信息
Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA.
Fox School of Business, Temple University, Philadelphia, Philadelphia, USA.
出版信息
Home Health Care Serv Q. 2020 Apr-Jun;39(2):51-64. doi: 10.1080/01621424.2020.1728464. Epub 2020 Feb 14.
We used 2010-16 Medicare Cost Reports for 10,737 freestanding home health agencies (HHAs) to examine the impact of home health (HH) and nursing home (NH) certificate-of-need (CON) laws on HHA caseload, total and per-patient variable costs. After adjusting for other HHA characteristics, total costs were higher in states with only HH CON laws ($2,975,698), only NH CON laws ($1,768,097), and both types of laws ($3,511,277), compared with no CON laws ($1,538,536). Higher costs were driven by caseloads, as CON reduced per-patient costs. Additional research is needed to distinguish whether this is due to skimping on quality vs. economies of scale.
我们使用了 2010-2016 年 Medicare 成本报告，对 10737 家独立家庭健康机构（HHAs）进行了研究，以考察家庭健康（HH）和疗养院（NH）需求证明（CON）法对 HHA 患者人数、总患者和人均可变成本的影响。在调整了其他 HHA 特征后，仅 HH CON 法（$2975698）、仅 NH CON 法（$1768097）和两种类型的 CON 法（$3511277）的州的总费用均高于无 CON 法（$1538536）的州。更高的成本是由患者人数驱动的，因为 CON 降低了人均成本。需要进行更多的研究来区分这是由于质量不足还是规模经济造成的。
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