Coe Norma B, Rosenkranz David A
Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Blockley Hall, Philadelphia, PA 19104, USA.
Department of Economics at Fordham University, 441 E Fordham Road, Dealy Hall, Bronx, NY 10458, USA.
J Public Econ. 2025 Aug;248. doi: 10.1016/j.jpubeco.2025.105435. Epub 2025 Jun 27.
Combining capitation with a cap on health care providers' average revenue can reduce allocative inefficiency. But the cap may be undercut by health care providers who churn their patient censuses. We investigate this possibility in the U.S. hospice industry, where Medicare pays hospice programs fixed daily rates but caps their average annual revenue. By leveraging variation generated by the cap's nonlinear design and the transition between fiscal years, we find that programs on track to exceed the cap raise enrollment rates by 5.8 % and live discharge rates by 4.3 % in the fourth quarter. But this churning falls far short of eliminating their financial penalties: it amounts to 10 % of an average program's excess revenue at most. Marginal enrollees have longer remaining lifetimes and more fragmented hospice spells on average, suggesting weaker intrinsic demand for hospice care. We discuss the cap's implications for market structure.
将按人头付费与对医疗服务提供者平均收入设置上限相结合，可以减少配置效率低下的问题。但这一上限可能会被那些频繁更换患者名单的医疗服务提供者削弱。我们在美国临终关怀行业研究了这种可能性，在该行业中，医疗保险按每日固定费率向临终关怀项目付费，但对其平均年收入设置了上限。通过利用上限的非线性设计以及财年之间的过渡所产生的差异，我们发现，在第四季度，即将超过上限的项目将入学率提高了5.8%，将存活出院率提高了4.3%。但这种人员更替远远不足以消除它们的经济处罚：最多相当于平均项目超额收入的10%。边际参保者平均剩余寿命更长，临终关怀期更分散，这表明对临终关怀服务的内在需求较弱。我们讨论了上限对市场结构的影响。
