VOLUNTARY REGULATION: EVIDENCE FROM MEDICARE PAYMENT REFORM

• 成果类型: Article
• 署名作者: Einav, Liran; Finkelstein, Amy; Ji, Yunan; Mahoney, Neale
• 署名单位: Stanford University; National Bureau of Economic Research; Massachusetts Institute of Technology (MIT); Harvard University
• 刊物名称: QUARTERLY JOURNAL OF ECONOMICS
• ISSN/ISSBN: 0033-5533
• DOI: 10.1093/qje/qjab035
• 发表日期: 2022
• 页码: 565-618
• 关键词: EXTREMITY JOINT REPLACEMENT; PHYSICIAN INCENTIVES; financial incentives; COST SAVINGS; care; PARTICIPATION; program; QUALITY; ARTHROPLASTY; discharge

摘要

Government programs are often offered on an optional basis to market participants. We explore the economics of such voluntary regulation in the context of a Medicare payment reform, in which one medical provider receives a single, predetermined payment for a sequence of related healthcare services, instead of separate service-specific payments. This bundled payment program was originally implemented as a five-year randomized trial, with mandatory participation by hospitals assigned to the new payment model; however, after two years, participation was made voluntary for half of these hospitals. Using detailed claim-level data, we document that voluntary participation is more likely for hospitals that can increase revenue without changing behavior (selection on levels) and for hospitals that had large changes in behavior when participation was mandatory (selection on slopes). To assess outcomes under counterfactual regimes, we estimate a stylized model of responsiveness to and selection into the program. We find that the current voluntary regime generates inefficient transfers to hospitals, and that alternative (feasible) designs could reduce these inefficient transfers and raise welfare. Our analysis highlights key design elements to consider under voluntary regulation.