Can cost shifting continue in a price competitive environment?
研究了医院在Medicare和Medicaid降低支付时，是否会向私人保险患者提高价格，利用加州1983-1991年数据发现医院确实会转移Medicare成本，但对Medicaid反应较小。
Both Medicare and Medicaid are reducing payments to hospitals, and there is widespread concern that hospitals may respond by increasing prices to privately insured patients. Theoretical models of hospital behaviour have ambiguous predictions as to whether, and under what circumstances, hospitals will shift costs to private payers. This paper extends previous theoretical models and then tests empirically using data from California for the 1983–1991 period, a time of increasingly intense price competition. Hospitals did increase their prices to private payers in response to reductions in Medicare rates; they had far smaller and generally insignificant responses to changes in Medicaid reimbursement. Hospital ownership and the competitiveness of the hospital market both affected this behaviour, but there was no significant change over time. The results suggest the need to broaden our models of hospital behaviour to ‘embed’ them in their local markets. Copyright © 2000 John Wiley & Sons, Ltd.