Vertical Integration and Cream Skimming of Profitable Referrals: The Case of Hospital-Owned Skilled Nursing Facilities

• 成果类型: Article
• 署名作者: Cutler, David; Dafny, Leemore; Grabowski, David C.; Lee, Steven; Ody, Christopher
• 署名单位: Harvard University; National Bureau of Economic Research; Harvard University; Brown University; Northwestern University; Analysis Group Inc.
• 刊物名称: AMERICAN ECONOMIC JOURNAL-ECONOMIC POLICY
• ISSN/ISSBN: 1945-7731
• DOI: 10.1257/pol.20200892
• 发表日期: 2026
• 关键词: PHYSICIAN PRACTICES; postacute care; patient; OWNERSHIP; QUALITY; cost; delivery; impacts; DESIGN

摘要

We examine whether vertical integration of hospitals and skilled nursing facilities (SNFs) could lessen competition by foreclosing rival SNFs'access to lucrative referrals. We find that it could: Among integrated providers, a 1 percent increase in SNF reimbursement for a given patient discharged from the upstream hospital increases the self-referral rate to the hospital's downstream SNF(s) by 1.8 percent. We find no evidence of offsetting benefits for patients and payers: These increased self-referrals have an imprecisely estimated zero effect on patient outcomes and Medicare spending. (JEL G34, I11, I13, J14, L14, L22)