Strategic Patient Discharge: The Case of Long-Term Care Hospitals

• 成果类型: Article
• 署名作者: Eliason, Paul J.; Grieco, Paul L. E.; McDevitt, Ryan C.; Roberts, James W.
• 署名单位: Brigham Young University; Pennsylvania Commonwealth System of Higher Education (PCSHE); Pennsylvania State University; Pennsylvania State University - University Park; Duke University; National Bureau of Economic Research; Duke University
• 刊物名称: AMERICAN ECONOMIC REVIEW
• ISSN/ISSBN: 0002-8282
• DOI: 10.1257/aer.20170092
• 发表日期: 2018
• 页码: 3232-3265
• 关键词: health-insurance; medicare; incentives; OWNERSHIP

摘要

Medicare's prospective payment system for long-term acute-care hospitals (LTCHs) provides modest reimbursements at the beginning of a patient's stay before jumping discontinuously to a large lump-sum payment after a prespecified number of days. We show that LTCHs respond to the financial incentives of this system by disproportionately discharging patients after they cross the large-payment threshold. We find this occurs more often at for-profit facilities, facilities acquired by leading LTCH chains, and facilities colocated with other hospitals. Using a dynamic structural model, we evaluate counterfactual payment policies that would provide substantial savings for Medicare.