Accounting System Management by Hospitals Operating in a Changing Regulatory Environment
研究医院在监管环境下如何通过高估合同调整额在支付方之间转移成本并增加收入，以及放松管制后这种行为的变化。
Under hospital accounting guidelines, contractual adjustments are an allowable deduction from revenue that reflect the difference between gross charges and reimbursement amounts. This study explores the use of contractual adjust- ments to shift costs among payors and increase revenues within a regulatory environment that attempted to limit cost shifting and set revenue constraints. Throughout the regulatory period, we find that hospitals overestimated budgeted contractual adjustments in a systematic manner which allowed cost shifting among payors and increased revenues. In addition, budgeted patient volumes and variable costs were manipulated in an attempt to relax the revenue constraint. After deregulation, we find that volume and cost biasing behavior decreased while overestimation of contractual adjustmentss increased. Further, we examine the interaction of this regulation with cost-containment regulation at the federal level.