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，如公共报告的医疗保健质量已成为流行的政策工具，旨在有效地提高质量，但其效果一直温和，有点不一致。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：未能考虑到支付政策和市场结构在供应商战略反应中的作用。公开报告可能，甚至很可能，促使某些供应商提高质量，而另一些供应商则不然，在政府管理价格和竞争较少等市场特点的背景下，质量下降甚至对某些供应商是最佳的。此外，任何供应商的战略反应可能不仅仅是质量的变化，而是价格，付款人组合或退出市场的变化。因此，我们不清楚是否应该期望公共报告改善福利，甚至提高质量。这种反应的异质性在文献中没有得到充分研究，但大量资源继续投入公共报告系统，医疗保健改革有望更加强调以市场为基础的改革。我们建议研究质量改进和预期的战略反应之间的关系，基于支付激励和结构特征的供应商和市场，从养老院的数据。我们的具体目标是：（1）评估在存在竞争性财务激励的情况下公开报告的效果;（2）评估在市场结构和报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，我们建议使用一个长面板（1998-2010年）的合并最小数据集数据和在线调查，认证和报告数据。这项研究有可能改变我们对医疗保健报告卡的看法，并在我们推进医疗改革的过程中提高质量和效率。

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.