Strategic Patient Discharge: The Case of Long-Term Care Hospitals
研究了美国长期急性护理医院如何利用医疗保险按服务付费系统的漏洞，在患者住院天数达到高额支付门槛后策略性地安排出院，以最大化收入。
Medicare’s prospective payment system for long-term acute-care hospitals (LTCHs) provides modest reimbursements at the beginning of a patient’s stay before jumping discontinuously to a large lump-sum payment after a prespecified number of days. We show that LTCHs respond to the financial incentives of this system by disproportionately discharging patients after they cross the large-payment threshold. We find this occurs more often at for-profit facilities, facilities acquired by leading LTCH chains, and facilities colocated with other hospitals. Using a dynamic structural model, we evaluate counterfactual payment policies that would provide substantial savings for Medicare.