Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market
Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market
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DOI：
10.1111/1475-6773.12059
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发表时间：
2013-10-01
影响因子：
3.4
通讯作者：
Escarce, Jose J.
中科院分区：
文献类型：
--
作者：
Huckfeldt, Peter J.;Sood, Neeraj;Escarce, Jose J.
目的了解医疗保险支付改革对急诊后医疗服务提供者进入和退出的影响。数据来源1991年至2010年的医疗保险服务提供者数据、成本报告和人口普查数据。研究设计我们检验了支付改革后进入和退出相对于先前存在的时间趋势的市场水平的变化。我们还比较了较高的联邦医疗保险份额市场相对于较低的联邦医疗保险份额市场的变化，以及相对于基于医院的设施的独立市场的变化。数据提取方法我们从服务提供商的文件中计算了1992年至2010年间家庭卫生机构、熟练护理机构和住院康复机构的市场级别的进入、退出和总存量。我们将这些措施与人口普查和美国社区调查中的人口信息、需要证法的信息以及从成本报告数据中得出的医疗设施在每个市场中的份额联系起来。主要发现支付改革减少了平均和边际支付，减少了进入市场和增加退出市场的机会。进入效应比退出效应更大、更持久。家庭健康机构的出入境比率波动更大，而不是熟练的护理机构。对提供者数量的影响与进入和退出的影响是一致的。结论支付改革影响市场进入和退出，进而可能影响市场结构、获得医疗服务的机会、医疗质量和成本以及患者结局。政策制定者在实施这些改革时，应考虑支付改革对急性后护理市场结构的潜在影响。
ObjectiveTo understand the impacts of Medicare payment reform on the entry and exit of post-acute providers.Data SourcesMedicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010.Study DesignWe examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities.Data Extraction MethodsWe calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data.Principal FindingsPayment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects.ConclusionsPayment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms.