School of Business, St. Bonaventure University, St. Bonaventure, NY 14778, USA.
School of Electronic Information, Huzhou College, Huzhou 313000, China.
Int J Environ Res Public Health. 2022 Oct 28;19(21):14110. doi: 10.3390/ijerph192114110.
Since FY 2013, as a part of the Affordable Care Act (ACA) program, the Hospital Value-Based Purchasing (HVBP) program has adjusted Medicare's payments to hospitals based on the total performance score of the hospital. First, the program reduces a portion of the hospital's Medicare payments in a specific fiscal year, and then, by the end of the same fiscal year, the amount of the payment reductions will be awarded to the hospitals based on the total performance score; thus, the hospitals that do not receive the reward will lose the portion of money reduced by Medicare. In this research, we apply the theory of state dependence and use the dynamic random effect probit model to estimate this effect. The results show that the hospital payment adjustment dynamics have a very significant state dependence effect (0.341); this means that hospitals that received a reward in the previous year are 34.1% more likely to receive a reward this year than the ones that received a penalty in the previous year. Meanwhile, we also find that the state dependence effect varies significantly across hospitals with different ownership (proprietary/government owned/voluntary nonprofit), and the results show that voluntary nonprofit hospitals exhibit the largest effect of state dependence (0.370), while government-owned hospitals exhibit the lowest effect of state dependence (0.293), and proprietary hospitals are in the middle. Among the factors that influence the likelihood that a hospital receives a reward, we find that teaching hospitals with a large number of beds (>400) are less likely be rewarded; in terms of ownership, we find that voluntary nonprofit hospitals are more likely be rewarded; in terms of demographic factors, hospitals where the average household income are higher within the region are more likely be rewarded.
自 2013 财年以来，作为平价医疗法案（ACA）计划的一部分，医院基于价值的采购（HVBP）计划根据医院的总绩效得分调整医疗保险对医院的支付。首先，该计划在特定财政年度减少医院的一部分医疗保险支付，然后，在同一财政年度结束时，根据总绩效得分向医院发放支付减少额的奖励；因此，未获得奖励的医院将失去医疗保险减少的部分资金。在这项研究中，我们应用状态依存理论，并使用动态随机效应概率模型来估计这种效应。结果表明，医院支付调整动态具有非常显著的状态依存效应（0.341）；这意味着，在上一年获得奖励的医院，今年获得奖励的可能性比上一年受到处罚的医院高 34.1%。同时，我们还发现，不同所有权（私营/政府所有/自愿非营利）的医院之间的状态依存效应差异显著，结果表明，自愿非营利性医院表现出最大的状态依存效应（0.370），而政府所有医院表现出最低的状态依存效应（0.293），私营医院则处于中间。在影响医院获得奖励的可能性的因素中，我们发现拥有大量床位（>400）的教学医院获得奖励的可能性较小；就所有权而言，我们发现自愿非营利性医院更有可能获得奖励；就人口统计学因素而言，所在地区平均家庭收入较高的医院更有可能获得奖励。
