谁来支付绩效工资?

IF 3.1 2区 经济学 Q1 ECONOMICS
Michael E Darden, Ian Paul McCarthy, E. Barrette
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引用次数: 0

摘要

公共绩效付费(P4P)计划将医院支付与预先确定的质量衡量标准挂钩,旨在鼓励或阻碍某些结果。从某种程度上说,这些项目的经济处罚会引起医院的一些反应,这种处罚可能会转化为商业保险付款人更高的协商付款。在本文中,我们使用来自大型多付款人数据库的商业保险支付数据来研究在医院再入院减少计划(HRRP)和医院基于价值的采购(HVBP)计划(《平价医疗法案》的两个主要P4P组成部分)下征收的罚款在多大程度上导致私立医院支付的变化。我们发现,HRRP和HVBP造成的大部分罚款都是由私人保险患者以更高的私人保险支付的形式承担的。具体而言,我们表明HRRP和HVBP的经济处罚导致私人支付增加1.9%,影响集中在循环系统程序中。这些处罚还与减少3.1%的医疗保险出院有关。对于私人保险患者比例较高的医院,我们的估计更大,这表明医院议价能力在促进更高的商业保险支付方面的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Who Pays in Pay-for-Performance?
Public pay-for-performance (P4P) programs tie hospital payments to predetermined sets of quality measures and are intended to encourage or discourage certain outcomes. To the extent that financial penalties from these programs induce some response by hospitals, such penalties may translate into higher negotiated payments from commercial insurance payers. In this paper, we employ data on commercial insurance payments from a large, multi-payer database to study the extent to which penalties levied under the Hospital Readmission Reduction Program (HRRP) and the Hospital Value-Based Purchasing (HVBP) program, two major P4P components of the Affordable Care Act, caused changes in private hospital payments. We find that the bulk of any penalties resulting from HRRP and HVBP are borne by private insurance patients in the form of higher private insurance payments. Specifically, we show that HRRP and HVBP financial penalties led to increases in private payments of 1.9 percent, with effects concentrated among circulatory system procedures. These penalties were also associated with a 3.1 percent reduction in Medicare discharges. Our estimates are larger for hospitals with higher shares of privately insured patients, which suggests the importance of hospital bargaining power in facilitating higher commercial insurance payments.
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来源期刊
CiteScore
4.30
自引率
2.70%
发文量
34
期刊介绍: The American Journal of Health Economics (AJHE) provides a forum for the in-depth analysis of health care markets and individual health behaviors. The articles appearing in AJHE are authored by scholars from universities, private research organizations, government, and industry. Subjects of interest include competition among private insurers, hospitals, and physicians; impacts of public insurance programs, including the Affordable Care Act; pharmaceutical innovation and regulation; medical device supply; the rise of obesity and its consequences; the influence and growth of aging populations; and much more.
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