NBER WORKING PAPER SERIES THE LONG-TERM IMPACT OF MEDICARE PAYMENT REDUCTIONS ON PATIENT OUTCOMES
NBER WORKING PAPER SERIES THE LONG-TERM IMPACT OF MEDICARE PAYMENT REDUCTIONS ON PATIENT OUTCOMES
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NBER 工作论文系列 医疗保险付款减少对患者预后的长期影响
DOI：
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Yu‐Chu Shen
中科院分区：
文献类型：
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作者：
V. Wu;Yu‐Chu Shen
这项研究探讨了医疗保险支付减少对病人的结果使用自然实验的长期影响平衡预算法案（BBA）的1997年。我们使用预测的医疗保险收入的变化，由于BBA，模拟BBA付款削减作为一种工具，分类医院的付款削减程度（小，中，大），并遵循医疗保险患者的结果，在这些医院超过11年的面板：1995-1997年前BBA，1998-2000年的BBA最初几年，和2001-2005年后BBA几年。我们发现，医疗保险急性心肌梗死死亡率趋势保持相似的医院之间比较前BBA和初始BBA期间。然而，2001-2005年的趋势开始出现分歧：在控制了BBA前的趋势之后，面临大幅削减付款的医院的死亡率相对于BBA后时期（2001-2005年）面临小幅削减的医院的死亡率有所上升。我们发现支持的一部分，较高的AMI死亡率之间的大型削减医院的解释是减少人员配备水平和运营成本后，支付削减。维维安·Y吴南加州大学政策、规划和发展学院650查尔兹路，RGL 305洛杉矶，CA 90089 vwu@nber.org玉珠商学院和公共政策研究生院海军研究生院555 Dyer Road Monterey，CA 93943和NBER yshen@nps.edu
This study examines the long term impact of Medicare payment reductions on patient outcomes using a natural experiment the Balance Budget Act (BBA) of 1997. We use predicted Medicare revenue changes due to BBA, with simulated BBA payment cuts as an instrument, to categorize hospitals by degrees of payment cuts (small, moderate, or large), and follow Medicare patient outcomes in these hospitals over a 11 year panel: 1995-1997 pre-BBA, 1998-2000 initial years of BBA, and 2001-2005 post-BBA years. We find that Medicare AMI mortality trends stay similar across hospitals when comparing between pre-BBA and initial-BBA periods. However, the trends began to diverge in 2001-2005: hospitals facing large payment cuts saw increased mortality rates relative to that of hospitals facing small cuts in the post-BBA period (2001-2005) after controlling for their pre-BBA trends. We find support that part of the higher AMI mortalities among large-cut hospitals are explained by reductions in staffing level and operating cost following the payment cuts. Vivian Y. Wu University of Southern California School of Policy, Planning, and Development 650 Childs Way, RGL 305 Los Angeles, CA 90089 vwu@nber.org Yu-Chu Shen Graduate School of Business and Public Policy Naval Postgraduate School 555 Dyer Road Monterey, CA 93943 and NBER yshen@nps.edu