PROSPECTIVE CASE-ADJUSTED PAYMENTS: PROFITS AND ACCESS

这是一项估计公司相对盈利能力的建议 明尼苏达州前瞻性病例调整后的不同病例类型 养老院的补偿制度，并调查是否 相对盈利能力对获得养老院护理的机会产生了影响。 病例组合的预期报销率可能不同于边际成本 出于这项研究中讨论的几个原因。具体而言，在 明尼苏达州的系统，病例混合部分的付款率很大程度上是 根据特定疗养院的滞后历史成本， 因此，由于以下原因，边际成本可能不同于边际收入： 集团确定的报销限额；滞后期；或变化 假定不随病例组合而变化的总成本的74%。 如果相对盈利能力出现差异，以及是否存在 一个州某些地区的短缺，低盈利能力的案例类型可能 体验访问问题，因为其他案例类型更有利可图。 这可能意味着绝对有利可图的案例类型可能不是 如果他们是所有案件类型中利润相对最低的，则承认。 我们计划使用明尼苏达州五年的数据来估计(平均) 年度总成本函数，我们将根据该函数计算边际成本。 由于明尼苏达州复杂的病例调整补偿制度， 我们将估计(平均)年总收入函数，根据该函数 我们将计算边际收入。我们将比较边际收益 用边际成本来确定是否盈利以及在哪里盈利 分歧是会发生的。如果盈利能力出现差异，我们将 确定无利可图或最无利可图的案例类型，并比较 随着时间的推移，这一类别中的疗养院患者数量。一个 这一案例数量的长期趋势可能反映了 接入问题，尽管可能有其他解释。知识 边际盈利能力的差异可能会有其他 这意味着什么。例如，盈利能力差异可能表明 需要在相对大小写混合权重或范围内进行调整 费用包含在基于案例的费率中。这项研究还 代表了理论成本函数文献的一个进步 因为我们的成本函数将更好地衡量临时 成本方面的产出变化。

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.