Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns.
Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns.
复制标题
DOI：
10.1086/677756
复制
发表时间：
2015-02-01
期刊：
影响因子：
--
通讯作者：
Kleiner S
中科院分区：
文献类型：
--
作者：
Doyle J;Graves J;Gruber J;Kleiner S
美国每年的医疗保险支出超过GDP的4%，有人担心道德风险问题导致了过度支出。这篇论文考虑了医院是否更积极地对待病人，并从医疗保险中获得更高的支付，以改善病人的健康状况。一项创新是用一种新的视角来比较医院对急诊病人的表现：住得很近的病人在救护车和公司的分配上似乎存在外生差异。利用2002-2010年的医疗保险数据，我们发现救护车公司分配对同一邮政编码的患者的医院选择有重要影响。使用纽约州2000-2006年的数据，将患者的确切地址与医院出院记录相匹配，我们表明，住得很近但在救护车服务区边界两侧的患者会去不同类型的医院。两种识别策略都表明，在各种紧急情况下，成本较高的医院可以获得更好的患者结果。使用我们的医疗保险样本，估计表明，医疗保险报销增加一个标准差导致死亡率降低4个百分点（与平均值相比降低10%）。考虑到健康危机后一年的支出，每挽救至少一年生命的隐含成本约为80 000美元。这些结果适用于不同类型的医院和患者，也适用于两种识别策略。
Medicare spending exceeds 4% of GDP in the US each year, and there are concerns that moral hazard problems have led to overspending. This paper considers whether hospitals that treat patients more aggressively and receive higher payments from Medicare improve health outcomes for their patients. An innovation is a new lens to compare hospital performance for emergency patients: plausibly exogenous variation in ambulance-company assignment among patients who live near one another. Using Medicare data from 2002–2010, we show that ambulance company assignment importantly affects hospital choice for patients in the same ZIP code. Using data for New York State from 2000–2006 that matches exact patient addresses to hospital discharge records, we show that patients who live very near each other but on either side of ambulance service area boundaries go to different types of hospitals. Both identification strategies show that higher-cost hospitals achieve better patient outcomes for a variety of emergency conditions. Using our Medicare sample, the estimates imply that a one standard deviation increase in Medicare reimbursement leads to a 4 percentage point reduction in mortality (10% compared to the mean). Taking into account one-year spending after the health shock, the implied cost per at least one year of life saved is approximately $80,000. These results are found across different types of hospitals and patients, as well across both identification strategies.
登录
查看更多内容
影响因子：
10.7
作者：
Doyle, Joseph J., Jr.
通讯作者：
Doyle, Joseph J., Jr.
影响因子：
9
作者：
Glance, Laurent G.;Dick, Andrew W.;Mukamel, Dana B.
通讯作者：
Mukamel, Dana B.
影响因子：
9.7
作者：
Hartman, Micah;Martin, Anne B.;Catlin, Aaron
通讯作者：
Catlin, Aaron
影响因子：
9.7
作者：
Fuchs, VR
通讯作者：
Fuchs, VR
影响因子：
8.2
作者：
Chandra, Amitabh;Staiger, Douglas O.
通讯作者：
Staiger, Douglas O.