Physician Payment Mechanisms, Hospital Length of Stay and Risk of Readmission: Evidence from a Natural Experiment
We provide an analysis of the effect of physician payment methods on their hospital patients' length of stay and risk of readmission. To do so, we exploit a major reform implemented in Quebec (Canada) in 1999. The Quebec Government introduced an optional mixed compensation (MC) scheme for specialist physicians working in hospital. This scheme combines a fixed per diem with a reduced fee for services provided, as an alternative to the traditional fee-for- service system. We develop a model of a physician's decision to choose the MC scheme. We show that a physician who adopts this system will have incentives to increase his time per clinical service provided. We demonstrate that as long as this effect does not improve his patients' health by more than a critical level, they will stay more days in hospital over the period. At the empirical level, we estimate a model of transition between spells in and out of hospital analog to a difference-in-differences approach. We find that the hospital length of stay of patients treated in departments that opted for the MC system increased on average by 5.3% (0.35 days). However, the risk of readmission to the same department with the same diagnosis does not appear to be overall affected by the reform.
|Date of creation:||Dec 2013|
|Date of revision:|
|Publication status:||forthcoming in: Journal of Health Economics|
|Contact details of provider:|| Postal: |
Phone: +49 228 3894 223
Fax: +49 228 3894 180
Web page: http://www.iza.org
|Order Information:|| Postal: IZA, Margard Ody, P.O. Box 7240, D-53072 Bonn, Germany|
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Heckman, James & Singer, Burton, 1984. "A Method for Minimizing the Impact of Distributional Assumptions in Econometric Models for Duration Data," Econometrica, Econometric Society, vol. 52(2), pages 271-320, March.
- Gaynor, Martin & Pauly, Mark V, 1990. "Compensation and Productive Efficiency of Partnerships: Evidence from Medical Group Practice," Journal of Political Economy, University of Chicago Press, vol. 98(3), pages 544-73, June.
- Baker, Michael & Melino, Angelo, 2000.
"Duration dependence and nonparametric heterogeneity: A Monte Carlo study,"
Journal of Econometrics,
Elsevier, vol. 96(2), pages 357-393, June.
- Michael Baker & Angelo Melino, 1999. "Duration Dependence and Nonparametric Heterogeneity: A Monte Carlo Study," Working Papers melino-99-01, University of Toronto, Department of Economics.
- Jaap H. Abbring & Gerard J. Van Den Berg, 2007.
"The unobserved heterogeneity distribution in duration analysis,"
Biometrika Trust, vol. 94(1), pages 87-99.
- Abbring, Jaap H & van den Berg, Gerard J, 2007. "The Unobserved Heterogeneity Distribution in Duration Analysis," CEPR Discussion Papers 6219, C.E.P.R. Discussion Papers.
- Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00305308, HAL.
- Han, Aaron & Hausman, Jerry A, 1990. "Flexible Parametric Estimation of Duration and Competing Risk Models," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 5(1), pages 1-28, January-M.
- Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2007.
"Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment,"
Cahiers de recherche
- Dumont, Etienne & Fortin, Bernard & Jacquemet, Nicolas & Shearer, Bruce, 2008. "Physicians' multitasking and incentives: Empirical evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 27(6), pages 1436-1450, December.
- Dumont, Etienne & Fortin, Bernard & Jacquemet, Nicolas & Shearer, Bruce S., 2007. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," IZA Discussion Papers 3229, Institute for the Study of Labor (IZA).
- Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce S. Shearer, 2008. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," CIRANO Working Papers 2008s-20, CIRANO.
- Meyer, Bruce D, 1990.
"Unemployment Insurance and Unemployment Spells,"
Econometric Society, vol. 58(4), pages 757-82, July.
- Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004.
"How Much Should We Trust Differences-in-Differences Estimates?,"
The Quarterly Journal of Economics,
MIT Press, vol. 119(1), pages 249-275, February.
- Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2002. "How Much Should We Trust Differences-in-Differences Estimates?," NBER Working Papers 8841, National Bureau of Economic Research, Inc.
- Christopher Ferrall & Allan W. Gregory & William Tholl, 1998. "Endogenous Work Hours and Practice Patterns of Canadian Physicians," Canadian Journal of Economics, Canadian Economics Association, vol. 31(1), pages 1-27, February.
- Blomquist, N Soren, 1989. "Comparative Statics for Utility Maximization Models with Nonlinear Budget Constraints," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 30(2), pages 275-96, May.
- Ellis, Randall P. & Ruhm, Christopher J., 1988. "Incentives to transfer patients under alternative reimbursement mechanisms," Journal of Public Economics, Elsevier, vol. 37(3), pages 381-394, December.
- David M. Cutler, 1993.
"The Incidence of Adverse Medical Outcomes Under Prospective Payments,"
NBER Working Papers
4300, National Bureau of Economic Research, Inc.
- Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
- 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.
- Ching-to Albert Ma & Thomas G. McGuire, 1995.
"Optimal Health Insurance and Provider Payment,"
0059, Boston University - Industry Studies Programme.
- Jack Hadley & James Reschovsky, 2006. "Medicare fees and physicians’ medicare service volume: Beneficiaries treated and services per beneficiary," International Journal of Health Care Finance and Economics, Springer, vol. 6(2), pages 131-150, June.
- Becker, Gary S & Lewis, H Gregg, 1973. "On the Interaction between the Quantity and Quality of Children," Journal of Political Economy, University of Chicago Press, vol. 81(2), pages S279-88, Part II, .
- Devlin, Rose Anne & Sarma, Sisira, 2008. "Do physician remuneration schemes matter? The case of Canadian family physicians," Journal of Health Economics, Elsevier, vol. 27(5), pages 1168-1181, September.
- Gabriel Picone & R. Mark Wilson & Shin-Yi Chou, 2003. "Analysis of hospital length of stay and discharge destination using hazard functions with unmeasured heterogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 12(12), pages 1021-1034.
- repec:hal:journl:halshs-00305308 is not listed on IDEAS
When requesting a correction, please mention this item's handle: RePEc:iza:izadps:dp7835. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Mark Fallak)
If references are entirely missing, you can add them using this form.