University of Pennsylvania, USA.
University of Chicago, USA.
J Health Econ. 2023 Dec;92:102823. doi: 10.1016/j.jhealeco.2023.102823. Epub 2023 Sep 25.
Nursing homes serve both long-term care and post-acute care (PAC) patients, two groups with distinct financing mechanisms and requirements for care. We examine empirically the effect of nursing home specialization in PAC using 2011-2018 data for Medicare patients admitted to nursing homes following a hospital stay. To address patient selection into specialized nursing homes, we use an instrumental variables approach that exploits variation over time in the distance from the patient's residential ZIP code to the closest nursing home with different levels of PAC specialization. We find that patients admitted to nursing homes more specialized in PAC have lower hospital readmissions and mortality, longer nursing home stays, and higher Medicare spending for the episode of care, suggesting that specialization improves patient outcomes but at higher costs.
养老院为长期护理和康复后护理（PAC）患者提供服务，这两个群体有不同的融资机制和护理要求。我们利用 2011-2018 年医疗保险患者在住院后入住养老院的数据，实证研究了养老院在 PAC 方面的专业化对患者的影响。为了解决患者选择进入专门的养老院的问题，我们采用了一种工具变量方法，该方法利用了患者居住的邮政编码与距离最近的具有不同 PAC 专业化程度的养老院之间的时间差异。我们发现，入住 PAC 专业化程度更高的养老院的患者的住院再入院率和死亡率更低，在养老院的停留时间更长，医疗保险对该护理阶段的支出也更高，这表明专业化提高了患者的治疗效果，但也增加了成本。
