Incentive Programs for Reducing Readmissions when Patient Care is Co-Produced

• 成果类型: Article
• 署名作者: Andritsos, Dimitrios A.; Tang, Christopher S.
• 署名单位: Hautes Etudes Commerciales (HEC) Paris; University of California System; University of California Los Angeles
• 刊物名称: PRODUCTION AND OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1059-1478
• DOI: 10.1111/poms.12847
• 发表日期: 2018
• 页码: 999-1020
• 关键词: co-productive services; hospital readmissions; Pay-for-performance; bundled payment

摘要

To reduce preventable readmissions, many healthcare systems are transitioning from fee-for-service (FFS) to other reimbursement schemes such as pay-for-performance (P4P) or bundled payment (BP) so that the funder of a healthcare system can transfer to the hospital some of the financial risks associated with patient rehospitalizations. To examine the effectiveness of different schemes (FFS, P4P, and BP), we develop a health co-production model in which the patient's readmissions can be jointly controlled by the efforts exerted by both the hospital and the patient. Our analysis of the equilibrium outcomes reveals that FFS cannot entice the hospital and the patient to exert readmission-reduction efforts. Relative to BP, we find that P4P is more effective in reducing readmissions over a wider range of scenarios. However, BP tends to be more effective in keeping lower combined patient costs and funder payments to the hospital. Finally, we find that some patient cost-sharing can be optimal for the funder under both P4P and BP.