Has the Medicare prospective payment system led to increased nursing home efficiency?
Has the Medicare prospective payment system led to increased nursing home efficiency?
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DOI：
10.1111/j.1475-6773.2007.00798.x
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发表时间：
2007-10
影响因子：
3.4
通讯作者：
N. Zhang;Lynn Unruh;T. Wan
中科院分区：
文献类型：
--
作者：
N. Zhang;Lynn Unruh;T. Wan
研究目的评估最近的医疗保险预期支付系统（PPS）的变化对熟练的养老院的效率的影响。数据来源/研究设置医疗保险成本报告（MCR），在线调查认证和报告系统（OSCAR），地区资源文件（ARF），医疗保险和医疗补助服务中心（CMS）医院工资指数网站，消费者价格指数（CPI）数据库和州医疗补助报销率调查。样本是1997年至2003年医疗保险成本报告数据库中的8,361家养老院。研究设计数据分析（DEA）计算三个独立的DEA模型的效率得分：未调整，敏锐度调整，敏锐度和质量调整的效率。这些模型的效率得分回归医疗保险PPS变化（平衡预算法案[BBA]，平衡预算细化法案[BBRA]和福利改善和保护法案）和其他组织和市场解释变量使用面板数据截断回归。主要发现所有效率指标的平均值随时间推移而下降，视力质量调整效率指标下降最多。所有的政策变量显着负相关的所有效率措施。除了敏锐度质量调整模型外，更高的护士配备与效率呈负相关。其他解释性变量与效率变量的关系各不相同。结论：结果表明，报销政策的变化对效率有显着的负面影响。较高的护士配置有助于较低的效率，只有当效率没有调整的质量。各种组织和市场因素也在所有效率模式中发挥重要作用。
RESEARCH OBJECTIVE To assess the impact of recent Medicare prospective payment system (PPS) changes on efficiency in skilled nursing homes. DATA SOURCE/STUDY SETTING Medicare Cost Reports (MCR), On-line Survey Certification and Reporting System (OSCAR), Area Resource Files (ARF), a Centers for Medicare and Medicaid Services (CMS) hospital wage index website, a Consumer Price Index (CPI) database, and a survey of state Medicaid reimbursement rates. The sample was 8,361 nursing homes in the Medicare Cost Report databases from the years 1997 to 2003. STUDY DESIGN Data-envelopment analyses (DEA) calculated efficiency scores for three separate DEA models: unadjusted, acuity-adjusted, and acuity-and-quality-adjusted efficiency. The efficiency scores from these models were regressed on the Medicare PPS changes (the Balanced Budget Act [BBA], the Balanced Budget Refinement Act [BBRA] and the Benefits Improvement and Protection Act) and other organizational and market explanatory variables using a panel-data truncated regression. PRINCIPAL FINDINGS Mean values for all efficiency measures decreased over time, the acuity-quality-adjusted efficiency measures decreasing the most. All policy variables were significantly negatively related to all efficiency measures. Higher nurse staffing was negatively related to efficiency in all but the acuity-quality-adjusted model. Other explanatory variables varied in their relationships to the efficiency variables. CONCLUSIONS The results suggest that the reimbursement policy changes had a significantly negative impact on efficiency. Higher nurse staffing contributed to lower efficiency only when efficiency was not adjusted for quality. Various organizational and market factors also played significant roles in all efficiency models.