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Int J Health Care Finance Econ. 2011 Sep;11(3):165-79. doi: 10.1007/s10754-011-9095-5. Epub 2011 Aug 18.

Vertical integration and optimal reimbursement policy.

Author information

1
Dapartment of Health Care Policy, Harvard Medical School, Boston, MA, USA.

Abstract

Health care providers may vertically integrate not only to facilitate coordination of care, but also for strategic reasons that may not be in patients' best interests. Optimal Medicare reimbursement policy depends upon the extent to which each of these explanations is correct. To investigate, we compare the consequences of the 1997 adoption of prospective payment for skilled nursing facilities (SNF PPS) in geographic areas with high versus low levels of hospital/SNF integration. We find that SNF PPS decreased spending more in high integration areas, with no measurable consequences for patient health outcomes. Our findings suggest that integrated providers should face higher-powered reimbursement incentives, i.e., less cost-sharing. More generally, we conclude that purchasers of health services (and other services subject to agency problems) should consider the organizational form of their suppliers when choosing a reimbursement mechanism.

PMID:
21850551
PMCID:
PMC3195424
DOI:
10.1007/s10754-011-9095-5
[Indexed for MEDLINE]
Free PMC Article

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