医院如何应对输入监管?来自加利福尼亚州护士配置授权的证据。

IF 3.4 2区 经济学 Q1 ECONOMICS
Chandni Raja
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引用次数: 0

摘要

20多年来,强制规定的最低护士与患者比例一直是美国积极辩论的主题,今天几个州和联邦层面正在立法考虑。本文以1999年加利福尼亚州护士配置任务为实证背景,估计最低比率对医院的因果影响。在接受治疗的医院中,最低比率使普通医疗/外科急诊室的每病患日护理时间增加了58分钟,每病患每日工资增加了9%。医院在几个方面做出了回应:增加了低执照和年轻护士的使用,减少了16张床位(14%),床位利用率提高了0.045个百分点(8%)。使用急性心肌梗死(AMI)出院的管理数据,我发现住院时间显著缩短(5%),对30天全因再入院率没有影响。对再次入院的无效影响表明,住院时间下降并不是因为医院让AMI患者出院“更快、病情更重”,而是因为每天的护理质量提高,AMI患者恢复得更快。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How do hospitals respond to input regulation? Evidence from the California nurse staffing mandate

Mandated minimum nurse-to-patient ratios have been the subject of active debate in the U.S. for over twenty years and are under legislative consideration today in several states and at the federal level. This paper uses the 1999 California nurse staffing mandate as an empirical setting to estimate the causal effects of minimum ratios on hospitals. Minimum ratios led to a 58 min increase in nursing time per patient day and 9 percent increase in the wage bill per patient day in the general medical/surgical acute care unit among treated hospitals. Hospitals responded on several margins: increased use of lower-licensed and younger nurses, reduced capacity by 16 beds (14 percent), and increased bed utilization rates by 0.045 points (8 percent). Using administrative data on discharges for acute myocardial infarction (AMI), I find a significant reduction in length of stay (5 percent) and no effect on the 30-day all-cause readmission rate. The null effect on readmissions suggests that length of stay declined not because hospitals were discharging AMI patients “quicker and sicker”, rather, AMI patients recovered more quickly due to an improvement in care quality per day.

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来源期刊
Journal of Health Economics
Journal of Health Economics 医学-卫生保健
CiteScore
6.10
自引率
2.90%
发文量
96
审稿时长
49 days
期刊介绍: This journal seeks articles related to the economics of health and medical care. Its scope will include the following topics: Production and supply of health services; Demand and utilization of health services; Financing of health services; Determinants of health, including investments in health and risky health behaviors; Economic consequences of ill-health; Behavioral models of demanders, suppliers and other health care agencies; Evaluation of policy interventions that yield economic insights; Efficiency and distributional aspects of health policy; and such other topics as the Editors may deem appropriate.
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