Profitability and Public Reporting: Evidence from Nursing Homes

盈利能力和公共报告：来自疗养院的证据

• 批准号: 8181241
• 负责人: RITA TAMARA KONETZKA
• 金额: $ 22.86万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8181241
• 关键词: Accounting; Address; Admission activity; Age; Certification; Characteristics; Data; Data Reporting; Data Set; Equilibrium; Face; Failure; Goals; Government; Health; Health Care Reform; Health Care Sector; Health Policy; Healthcare; Healthcare Market; Heterogeneity; Home Nursing Care; Incentives; Intuition; Lead; Literature; Marketing; Measures; Medicaid; Medicare; Nursing Homes; Patients; Policies; Population; Price; Provider; Public Domains; Quality of Care; Relative (related person); Reporting; Research; Resources; Role; Social Welfare; Statutes and Laws; Structure; Surveys; System; Time; Variant; base; cost; design; experience; financial incentive; health care quality; improved; payment; response; success; theories; tool

DESCRIPTION (provided by applicant): Market-based reforms such as public reporting of health care quality have become popular policy tools intended to improve quality efficiently, but their effects have been modest and somewhat inconsistent. The objective of this study is to enhance public reporting policies by exploring a primary reason for their lack of success: the failure to account for the roles of payment policy and market structure in the strategic response of providers. Public reporting may possibly, and even likely, lead to an incentive to improve quality for some providers but not for others, with decreases in quality even being optimal for some providers in the context of such market features as government administered prices and less competition. Furthermore, the strategic response of any provider may not simply be a change in quality but rather a change in price, payer mix, or exit from the market. It is therefore unclear whether we should expect public reporting to be welfare-improving or even quality-improving. This type of heterogeneity of response has been understudied in the literature, yet substantial resources continue to be poured into public reporting systems, with health care reform promising even more emphasis on market-based reforms. We propose to examine the relationship between quality improvement and expected strategic response based on payment incentives and structural characteristics of providers and markets, drawing on data from nursing homes. Our Specific Aims are: 1) To assess the effect of public reporting in the presence of competing financial incentives, and 2) To assess strategic response to public reporting within the context of market structure and payment incentives. To address these aims, we propose to use a long panel (1998-2010) of merged Minimum Data Set data and Online Survey, Certification, and Reporting data. This research has the potential to change the way we think about health care report cards and their ability to incent quality and efficiency as we move forward in the implementation of health reform. PUBLIC HEALTH RELEVANCE: Our overall goal in this study is to improve the quality of care for nursing home residents by critically examining and developing improvements to a major policy initiative -public reporting of quality information- in terms of the interaction between this initiative and the competing incentives that providers face. Nursing home care is a critical health care and health policy issue which promises to become even more important and costly as the population ages.

描述（由申请人提供）：基于市场的改革（例如公开报告医疗保健质量）已成为旨在有效提高质量的流行政策工具，但其效果有限且有些不一致。本研究的目的是通过探索公共报告政策失败的主要原因来加强公共报告政策：未能考虑到支付政策和市场结构在提供商战略反应中的作用。公开报告可能甚至很可能会激励某些提供商提高质量，但对其他提供商则不然，在政府管理价格和竞争较少等市场特征的背景下，质量下降甚至对某些提供商来说是最优的。此外，任何提供商的战略反应可能不仅仅是质量的变化，而是价格、支付者组合或退出市场的变化。因此，尚不清楚我们是否应该期望公共报告能够改善福利，甚至提高质量。这种反应的异质性在文献中尚未得到充分研究，但大量资源继续投入到公共报告系统中，医疗保健改革有望更加强调基于市场的改革。我们建议根据支付激励以及提供者和市场的结构特征，并借鉴疗养院的数据，研究质量改进与预期战略响应之间的关系。我们的具体目标是：1) 在存在竞争性财务激励的情况下评估公开报告的效果，以及 2) 在市场结构和支付激励的背景下评估对公开报告的战略反应。为了实现这些目标，我们建议使用合并最小数据集数据和在线调查、认证和报告数据的长面板（1998-2010）。随着我们推进医疗改革的实施，这项研究有可能改变我们对医疗保健成绩单及其提高质量和效率的能力的看法。 公共卫生相关性：本研究的总体目标是通过严格审查和改进一项主要政策举措（质量信息的公开报告），以提高疗养院居民的护理质量，并考虑该举措与竞争性政策之间的相互作用。提供商面临的激励措施。疗养院护理是一个重要的医疗保健和卫生政策问题，随着人口老龄化，它可能会变得更加重要和昂贵。