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PROSPECTIVE CASE-ADJUSTED PAYMENTS: PROFITS AND ACCESS

预期的案例调整付款：利润和访问权限

基本信息

批准号：
3372649
负责人：
John A Nyman
金额：
$ 6.78万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
1991
资助国家：
美国
起止时间：
1991-09-30 至 1993-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/3372649
关键词：
case history frail elderly health care cost /financing health care service availability health care service evaluation health care service planning health care service utilization health economics health insurance human old age (65+) mathematical model nursing homes socioeconomics statistics /biometry

项目摘要

This is a proposal to estimate the relative profitability of the different casetypes in Minnesota's prospective case-adjusted reimbursement system for nursing homes, and to investigate whether relative profitability has had an effect on access to nursing home care. Case-mix prospective reimbursement rates may differ from marginal costs for several reasons discussed in this study. Specifically, in Minnesota's system, the case mix portion of the payment rates is largely based on the lagged historical costs of a particular nursing home, therefore marginal costs may differ from marginal revenue due to: group-determined reimbursement limits; the lag period; or variation of the 74% of total costs which are assumed not to vary with case mix. If differences in relative profitability occur and if there are bed shortages in certain areas of a state, low profitability casetypes may experience access problems because other casetypes are more profitable. This could mean that an absolutely profitable case type might not be admitted if they are relatively the least profitable of all case types. We plan to use Minnesota data from five years to estimate an (average) annual total cost function, from which we will calculate marginal cost. Because of Minnesota's complicated case-adjusted reimbursement system, we will estimate an (average) annual total revenue function from which we will calculate marginal revenue. We will compare marginal revenues with marginal costs to determine whether and where profitability differences occur. If differences in profitability occur, we will then identify the unprofitable or least profitable casetype, and compare the number of nursing home patients in this category over time. A diminishing secular trend in the volume of this casetype may reflect access problems, although there could be other explanations. Knowledge that differences in marginal profitability occur may have other implications. For example, profitability differences might indicate need for adjustments either in relative case mix weights or in the scope of costs included in the case based rates. This research also represents an advance in the theoretical cost function literature because our cost function will better gauge the impact of temporary changes in outputs on costs.

这是一个建议，以估计相对盈利能力的明尼苏达州前瞻性病例调整的不同病例类型养老院的报销制度，并调查是否相对的盈利能力对获得疗养院护理产生了影响。病例组合预期偿还率可能与边际费用不同在本研究中讨论了几个原因。具体到明尼苏达州的系统，案件组合部分的支付率主要是基于特定疗养院的滞后历史成本，因此，边际成本可能不同于边际收益，原因如下：组确定的报销限额;滞后期;或假设总成本的74%不随病例组合而变化。如果相对盈利能力出现差异，在一个国家的某些地区短缺，低盈利能力的情况下，由于其他案件类型更有利可图，因此会遇到准入问题。这可能意味着一个绝对有利可图的案件类型可能不会如果它们是所有案件类型中相对最不有利可图的，则被接纳。我们计划使用明尼苏达州五年的数据来估计（平均）年总成本函数，从中我们将计算边际成本。由于明尼苏达州复杂的病例调整报销制度，我们将估计（平均）年总收入函数，我们将计算边际收益。我们将比较边际收益用边际成本来决定是否以及在哪里盈利差异发生。如果盈利能力出现差异，我们将确定无利可图或利润最低的案例类型，并比较随着时间的推移，此类护理院患者的数量。一这种病例数量的长期下降趋势可能反映了准入问题，尽管可能有其他解释。知识边际利润率的差异可能会有其他含义。例如，盈利能力差异可能表明需要在相对病例组合权重或范围方面进行调整包括在基于案例的费率中的费用。本研究也代表了理论成本函数文献的进步因为我们的成本函数可以更好地衡量成本产出的变化。