Market Competition and the Quality of Home Health Services

描述（由申请人提供）：高质量和运作良好的家庭医疗保健行业是综合医疗保健系统的重要组成部分，旨在降低医疗保健成本并改善人口的健康状况。最近，联邦政府采取了以市场为基础的改革，通过公开质量信息的报告和基于提供者表现的报销来提高医疗保健系统的质量。2004年，联邦政府启动了报告质量信息的《家庭卫生质量倡议》，将这些改革扩展到家庭保健部门。此外，还计划支付家庭保健方面的绩效工资。这些改革需要一个运作良好的竞争性市场来实现其既定目标。然而，在制定有约束力的需求证明（CON）法规的州，竞争可能会受到抑制，这些法规旨在限制家庭保健机构的进入。本项目的目标是建立家庭健康行业竞争与质量之间的关系，以及竞争与家庭健康健康市场改革之间的关系。检验竞争是否能提高质量，检验HHQI是否能提高质量，检验HHQI在竞争更激烈的市场上的质量提高是否更大。我们的方法是通过创建2001-2006年患者、机构和市场的分层面板文件来分析美国所有家庭医疗保健市场的竞争和质量。该文件将根据Medicare和OASIS数据创建，方法是将医院的Medicare索赔链接到家庭健康机构索赔，将从医院出院的患者的OASIS数据链接到家庭健康机构。我们将使用赫芬达尔-赫希曼指数作为竞争和家庭病例访问、功能状态改善、再入院和不良事件作为质量指标的衡量标准。我们的分析将涉及使用面板和工具变量计量经济学技术。我们的最终目标是通过公司进入、信息报告和绩效支付来促进质量竞争的政策措施，为政策提供信息。公共卫生相关性：出于对提高家庭保健服务质量的兴趣，本申请旨在确定竞争更激烈的家庭保健市场是否提供更高质量的护理，以及2004年家庭保健质量倡议是否在竞争更激烈的市场中更好地提高了质量。

DESCRIPTION (provided by applicant): A high quality and well functioning home health care industry is an essential part of an integrated health care system that strives to reduce health care costs and improve the health outcomes of the population. Recently the federal government has embraced market-based reforms to improve the quality of the health care system through public reporting of quality information and by basing reimbursement on the provider performance. These reforms reach the home health care sector in 2004 when the federal government launched the Home Health Quality Initiative (HHQI) for reporting of quality information. Pay for performance in home health is also planned. These reforms require a well functioning competitive market to achieve their stated aims. Yet competition may be stifled in home health in states with binding Certificate of Need (CON) regulations which are designed restrict entry of home health agencies. The goal of this project is to establish the relationship between competition and quality in the home health industry and the relationship between competition and the market-based reform of HHQI. We will test whether competition improves quality, whether HHQI improves quality, and whether the quality improvement from HHQI is greater in more competitive markets. Our approach is to analyze competition and quality for all home health care markets in the U.S. by creating a hierarchical panel file for the years 2001-2006 of patients, agencies, and markets. The file will be created from Medicare and OASIS data by linking Medicare claims for hospitals to the home health agency claim and OASIS data for those patients discharged from the hospital to the home health agency. We will use the Herfindahl-Hirschman Index as our measure of competition and home case visits, functional status improvements, readmissions, and adverse events as indicators of quality. Our analyses will involve the use of panel and instrumental variables econometric techniques. Ultimately our goal is to inform policy with respect to policy measures that promote competition on quality through firm entry, information reporting, and payment for performance. PUBLIC HEALTH RELEVANCE: With an interest in improving the quality of home health care delivery, this application aims to determine whether more competitive home health markets have higher quality care and whether the Home Health Quality Initiative of 2004 improved quality more in the more competitive markets.