Patient versus Provider Incentives in Long-Term Care

• 成果类型: Article
• 署名作者: Hackmann, Martin B.; Pohl, R. Vincent; Ziebarth, Nicolas R.
• 署名单位: University of California System; University of California Los Angeles; National Bureau of Economic Research; University of Mannheim; University of Mannheim; Leibniz Association; Zentrum fur Europaische Wirtschaftsforschung (ZEW); Cornell University; IZA Institute Labor Economics
• 刊物名称: AMERICAN ECONOMIC JOURNAL-APPLIED ECONOMICS
• ISSN/ISSBN: 1945-7782
• DOI: 10.1257/app.20210264
• 发表日期: 2024
• 页码: 178-218
• 关键词: nursing-home residents; health-insurance experiment; financial incentives; medicaid; QUALITY; discharge; payment; demand; reimbursement; transitions

摘要

How do patient and provider incentives affect the provision of long-term care? Our analysis of 551,000 nursing home stays yields three main insights. First , due to limited cost -sharing, Medicaidcovered residents prolong their nursing home stays instead of transitioning to community -based care. Second , when facility capacity binds , nursing homes shorten Medicaid stays to admit more profitable out-of-pocket private payers. Third , providers react more elastically to financial incentives than patients. Thus , targeting provider incentives through alternative payment models , such as episode -based reimbursement , is more effective than increasing patient cost sharing in facilitating transitions to community -based care and generating long-term care savings. ( JEL H51, H75, I11, I13, I18, I38, L84)