Monitoring for Waste: Evidence from Medicare Audits

• 成果类型: Article
• 署名作者: Shi, Maggie
• 署名单位: University of Chicago; National Bureau of Economic Research
• 刊物名称: QUARTERLY JOURNAL OF ECONOMICS
• ISSN/ISSBN: 0033-5533
• DOI: 10.1093/qje/qjad049
• 发表日期: 2024
• 页码: 993-1049
• 关键词: CARE EVIDENCE; moral hazard; Hospitals; COSTS; identification; INFORMATION; incentives; allocation; crime

摘要

This article examines the trade-offs of monitoring for wasteful public spending. By penalizing unnecessary spending, monitoring improves the quality of public expenditure and incentivizes firms to invest in compliance technology. I study a large Medicare program that monitored for unnecessary health care spending and consider its effect on government savings, provider behavior, and patient health. Every dollar Medicare spent on monitoring generated $24-$29 in government savings. The majority of savings stem from the deterrence of future care, rather than reclaimed payments from prior care. I do not find evidence that the health of the marginal patient is harmed, indicating that monitoring primarily deters low-value care. Monitoring does increase provider administrative costs, but these costs are mostly incurred up-front and include investments in technology to assess the medical necessity of care.