Incentive Programs for Reducing Readmissions when Patient Care is Co‐Produced
研究比较了按服务收费、按绩效付费和捆绑支付三种报销方案在减少患者再入院方面的效果，发现按绩效付费在更多情况下更有效，而捆绑支付能降低患者总费用和支付方支出。
To reduce preventable readmissions, many healthcare systems are transitioning from fee‐for‐service (FFS) to other reimbursement schemes such as pay‐for‐performance (P4P) or bundled payment (BP) so that the funder of a healthcare system can transfer to the hospital some of the financial risks associated with patient rehospitalizations. To examine the effectiveness of different schemes (FFS, P4P, and BP), we develop a “health co‐production” model in which the patient's readmissions can be “jointly controlled” by the efforts exerted by both the hospital and the patient. Our analysis of the equilibrium outcomes reveals that FFS cannot entice the hospital and the patient to exert readmission‐reduction efforts. Relative to BP, we find that P4P is more effective in reducing readmissions over a wider range of scenarios. However, BP tends to be more effective in keeping lower combined patient costs and funder payments to the hospital. Finally, we find that some patient cost‐sharing can be optimal for the funder under both P4P and BP.