Hospital Integration and Medicare Reimbursement Policy

描述（由申请人提供）：本项目将评估急症护理医院与专业护理和家庭卫生保健市场垂直整合对卫生保健实践、成本和患者健康结果的影响。它将表明整合是否会导致医院为患者提供效率更高或效率更低的急性护理、熟练护理和家庭护理组合。此外，它将确定如何设计医疗保险报销政策，以利用效率效益并避免整合的效率成本。该项目将分析一体化对1997-2004年期间入住急症护理医院的基本上所有按服务收费的老年医疗保险受益人的影响。我们将重点关注以前文献中发现的疾病，这些疾病使患者处于需要急性后护理的高风险中。具体目标是：(1)将全面的全国医疗保险数据与所有美国医院、所有美国多医院系统和其他影响治疗决策的地区级因素的数据相匹配，这些数据涉及个体患者对急性护理、熟练护理和家庭健康的利用、支出和健康结果；(2)评估急症医院垂直整合的决定因素；(3)在保持患者、医院和地理区域特征不变的情况下，评估急症医院垂直整合对患者护理成本和质量的影响；(4)区分整合的效率提升效应和效率降低效应；(5)确定作为1997年平衡预算法案（BBA 1997）及其后续法律的一部分，医疗保险报销政策的变化如何影响整合的效率提升效应和效率降低效应；(6)提出新的医疗保险报销政策改革，以利用效率效益，避免整合的效率成本。

DESCRIPTION (provided by applicant): This project will estimate the effects of vertical integration by acute care hospitals into markets for skilled nursing and home health care on health care practices, costs, and patient health outcomes. It will indicate whether integration leads hospitals to provide patients with a more-efficient or less-efficient mix of acute care, skilled nursing care, and care in the home. In addition, it will identify how Medicare reimbursement policy can be designed to harness the efficiency benefits and avoid the efficiency costs of integration. The project will analyze the consequences of integration for essentially all elderly fee-for-service Medicare beneficiaries admitted to an acute care hospital from 1997-2004. We will focus on illnesses found in the previous literature to put a patient at high risk for need of post-acute care. The specific aims are: (1) to match comprehensive nationwide Medicare data on individual patients' utilization of acute-care, skilled-nursing, and home-health utilization, expenditures, and health outcomes with data on all U.S. hospitals, on all U.S. multi hospital systems, and on other area-level factors affecting treatment decisions; (2) to estimate the determinants of vertical integration by acute care hospitals; (3) to estimate the effect of vertical integration by acute care hospitals on the cost and quality of patient care, holding constant the characteristics of patients, hospitals, and geographic areas; (4) to distinguish the efficiency-enhancing effects of integration from the efficiency-reducing effects; (5) to identify how changes in Medicare reimbursement policy adopted as part of the Balanced Budget Act of 1997 (BBA 1997) and subsequent laws affected both the efficiency-enhancing effects and the efficiency-reducing effects of integration; and (6) to propose new reforms to Medicare reimbursement policy in order to harness the efficiency benefits and avoid the efficiency costs of integration.