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，致力于降低医疗保健成本和改善人口的健康结果。最近，联邦政府已经接受了基于市场的改革，通过公开报告质量信息和根据提供者的表现进行报销，来提高医疗保健系统的质量。2004年，当联邦政府发起家庭健康质量倡议以报告质量信息时，这些改革涉及到家庭保健部门。还计划按家庭保健方面的业绩支付报酬。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，在具有约束力的需求证明（CON）法规的州，家庭保健领域的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。本研究的目标是建立家庭健康产业竞争与质量的关系，以及竞争与HHQI市场化改革的关系。我们将测试竞争是否提高了质量，HHQI是否提高了质量，以及HHQI的质量改进是否在竞争更激烈的市场中更大。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。该文件将通过将医院的医疗保险索赔与家庭健康机构索赔以及从医院出院到家庭健康机构的患者的OASIS数据联系起来，从医疗保险和OASIS数据中创建。我们将使用Herfindahl-Hirschman指数作为竞争和家庭病例访视、功能状态改善、再入院和不良事件的指标，作为质量指标。我们的分析将涉及使用面板和工具变量计量经济学技术。最终，我们的目标是为政策提供信息，通过企业进入、信息报告和绩效支付来促进质量竞争的政策措施。公共卫生相关性：为了提高家庭保健服务的质量，本申请旨在确定竞争更激烈的家庭保健市场是否有更高质量的保健，以及2004年的家庭保健质量倡议是否在竞争更激烈的市场中提高了质量。

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.