Hospital Integration and Medicare Reimbursement Policy

描述（由申请人提供）：本项目将评估急性护理医院垂直整合到专业护理和家庭医疗保健市场对医疗保健实践、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更有效或效率较低的急性护理，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，以利用效率的好处，避免效率成本的整合。该项目将分析1997年至2004年期间入住急诊医院的基本上所有老年按服务收费医疗保险受益人的整合后果。我们将重点关注在以前的文献中发现的疾病，使患者处于需要急性后护理的高风险。具体目标是：（1）将关于个体患者对急性护理、熟练护理和家庭健康利用、支出和健康结果的综合性全国医疗保险数据与所有美国医院、所有美国多医院系统以及影响治疗决策的其他地区因素的数据相匹配;（2）估计急性护理医院垂直整合的决定因素;（3）在保持病人、医院和地理区域的特征不变的情况下，估计急性护理医院纵向一体化对病人护理成本和质量的影响;（4）区分一体化的效率提高效应和效率降低效应;（5）确定作为1997年平衡预算法案一部分的医疗保险报销政策的变化（BBA 1997）和随后的法律影响了一体化的效率提高效果和效率降低效果;（6）提出新的医疗保险报销政策改革方案，以充分利用整合带来的效率效益，避免整合带来的效率成本。

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.