Profitability and Public Reporting: Evidence from Nursing Homes

描述（由申请人提供）：以市场为基础的改革，如卫生保健质量的公开报告，已成为旨在有效提高质量的流行政策工具，但其效果不大，而且有些不一致。本研究的目的是通过探索公共报告政策缺乏成功的主要原因来加强公共报告政策：未能考虑支付政策和市场结构在供应商战略反应中的作用。公开报告有可能，甚至很可能促使一些提供者提高质量，而另一些提供者却没有，在政府管理价格和竞争较少等市场特征的情况下，质量下降对一些提供者来说甚至是最佳的。此外，任何供应商的战略反应可能不仅仅是改变质量，而是改变价格、付款人组合或退出市场。因此，我们不清楚的是，我们是否应该期望公共报告能够改善福利，甚至提高质量。这种类型的异质性反应在文献中尚未得到充分研究，但大量资源继续投入公共报告系统，医疗改革承诺更加强调市场改革。我们建议基于支付激励和提供者和市场的结构特征，利用养老院的数据来检验质量改进和预期战略反应之间的关系。我们的具体目标是：1)评估在竞争性财务激励存在的情况下公开报告的效果；2)评估在市场结构和薪酬激励的背景下对公开报告的战略反应。为了实现这些目标，我们建议使用合并的最小数据集数据和在线调查、认证和报告数据的长面板（1998-2010）。这项研究有可能改变我们对医疗报告卡的看法，以及在我们推进医疗改革的过程中，报告卡激励质量和效率的能力。

DESCRIPTION (provided by applicant): Market-based reforms such as public reporting of health care quality have become popular policy tools intended to improve quality efficiently, but their effects have been modest and somewhat inconsistent. The objective of this study is to enhance public reporting policies by exploring a primary reason for their lack of success: the failure to account for the roles of payment policy and market structure in the strategic response of providers. Public reporting may possibly, and even likely, lead to an incentive to improve quality for some providers but not for others, with decreases in quality even being optimal for some providers in the context of such market features as government administered prices and less competition. Furthermore, the strategic response of any provider may not simply be a change in quality but rather a change in price, payer mix, or exit from the market. It is therefore unclear whether we should expect public reporting to be welfare-improving or even quality-improving. This type of heterogeneity of response has been understudied in the literature, yet substantial resources continue to be poured into public reporting systems, with health care reform promising even more emphasis on market-based reforms. We propose to examine the relationship between quality improvement and expected strategic response based on payment incentives and structural characteristics of providers and markets, drawing on data from nursing homes. Our Specific Aims are: 1) To assess the effect of public reporting in the presence of competing financial incentives, and 2) To assess strategic response to public reporting within the context of market structure and payment incentives. To address these aims, we propose to use a long panel (1998-2010) of merged Minimum Data Set data and Online Survey, Certification, and Reporting data. This research has the potential to change the way we think about health care report cards and their ability to incent quality and efficiency as we move forward in the implementation of health reform.