Medicare Hospice Benefit: The Effectiveness of Price Incentives in Health Care Policy. Executive Summary

摘要

The dissertation examines the effects of fixed-price reimbursement on the provision of care within the Medicare Hospice Benefit Program. The Benefit is found to increase access to hospice care by enabling certified facilities to serve more patients than if they were non-certified. However, wage indices used to adjust reimbursement rates across different parts of the country do not appear to correctly adjust for differences in labor costs. The resulting disparities in real returns to certification play a significant role in explaining variations in regional certification rates, which in turn have implications for access to high quality hospice care. Two alternative wage indices could dramatically narrow disparities in regional certification. The second essay looks for differential responses to the Benefit across ownership types. The authors find little difference in costs or quality of service between government, for-profit, and non-profit hospices. However, significant differences in the number of patients across ownership status exist. The results imply that nonprofit hospices are patient-maximizers, not profit-maximizers. The similarity of these results with those in the hospital industry imply that Medicare regulations and the predominance of Medicare revenues in the hospice industry induce similar outcomes in cost and quality across ownership forms.