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Heterogeneous effect of prospective payment system on hospital’s volume and quality

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  • Galina Besstremyannaya

    ()
    (CEFIR)

  • Dmitry Shapiro

    ()
    (Belk College of Business, University of North Carolina)

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    Abstract

    In early 2000s Japan introduced a special version of an inpatient prospective payment system (PPS) that contains incentives to increase efficiency and shorten the average length of stay (ALOS). This paper presents a theoretical model, which explains heterogeneous dynamics of volume and quality in a mixed PPS system. The model exploits two essential features of Japanese PPS: per diem payments and a length-of-stay dependent PPS tariff. The novelty of the model is that it incorporates hospital’s heterogeneity through an explicit parameter of hospital’s cost efficiency. The model predicts different directions of the change in ALOS for efficient and inefficient hospitals. Moreover, the decline in ALOS is shown to be associated with a rise in the rate for planned early readmissions. Using an administrative database for 684 Japanese PPS hospitals in 2007-2011, we conduct avearge treatment effect estimations with dynamic panel data and nd an empirical support for the predictions of the theoretical model.

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    Bibliographic Info

    Paper provided by Center for Economic and Financial Research (CEFIR) in its series Working Papers with number w0181.

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    Length: 28 pages
    Date of creation: Nov 2012
    Date of revision:
    Handle: RePEc:cfr:cefirw:w0181

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    1. Cutler, D.M., 1992. "The Incidence of Adverse Medical Outcome Under Prospective Payment," Harvard Institute of Economic Research Working Papers 1603, Harvard - Institute of Economic Research.
    2. Newhouse, Joseph P. & Byrne, Daniel J., 1988. "Did Medicare's Prospective Payment System cause length of stay to fall?," Journal of Health Economics, Elsevier, vol. 7(4), pages 413-416, December.
    3. Randall P. Ellis & Thomas G. McGuire, 1994. "Hospital Response to Prospective Payment: Moral Hazard, Selection, and Practice-Style Effects," Papers 0050, Boston University - Industry Studies Programme.
    4. Neeraj Sood & Melinda Beeuwkes Buntin & Jose J. Escarce, 2006. "Does How Much and How You Pay Matter? Evidence from the Inpatient Rehabilitation Facility Prospective Payment System," NBER Working Papers 12556, National Bureau of Economic Research, Inc.
    5. M Arellano & O Bover, 1990. "Another Look at the Instrumental Variable Estimation of Error-Components Models," CEP Discussion Papers dp0007, Centre for Economic Performance, LSE.
    6. Pope, Gregory C., 1989. "Hospital nonprice competition and medicare reimbursement policy," Journal of Health Economics, Elsevier, vol. 8(2), pages 147-172, June.
    7. Jean-Jacques Laffont & Jean Tirole, 1993. "A Theory of Incentives in Procurement and Regulation," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262121743, December.
    8. Blundell, R. & Bond, S., 1995. "Initial Conditions and Moment Restrictions in Dynamic Panel Data Models," Economics Papers 104, Economics Group, Nuffield College, University of Oxford.
    9. Grabowski, David C. & Afendulis, Christopher C. & McGuire, Thomas G., 2011. "Medicare prospective payment and the volume and intensity of skilled nursing facility services," Journal of Health Economics, Elsevier, vol. 30(4), pages 675-684, July.
    10. Sood, Neeraj & Buntin, Melinda Beeuwkes & Escarce, José J., 2008. "Does how much and how you pay matter? Evidence from the inpatient rehabilitation care prospective payment system," Journal of Health Economics, Elsevier, vol. 27(4), pages 1046-1059, July.
    11. Windmeijer, Frank, 2005. "A finite sample correction for the variance of linear efficient two-step GMM estimators," Journal of Econometrics, Elsevier, vol. 126(1), pages 25-51, May.
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