Data and Code for: Patient Versus Provider Incentives in Long-Term Care

How do patient and provider incentives affect the provision of long-term care? Our analysis of 551 thousand nursing home stays yields three main insights. First, Medicaid-covered residents prolong their stays instead of transitioning to community-based care due to limited cost-sharing. Second, when facility capacity binds, nursing homes shorten Medicaid stays to admit more profitable out-of-pocket private payers. Third, providers react more elastically to financial incentives than patients. Thus, targeting provider incentives through alternative payment models, such as episode-based reimbursement, is more effective than increasing patient cost-sharing in facilitating transitions to community-based care and generating long-term care savings.

患者与医护机构的激励措施如何影响长期照护服务的供给？本研究通过对55.1万次疗养院入住案例的分析，得出三项核心结论。其一，享受医疗补助计划（Medicaid）的入住者因共付费用受限，选择延长入住时长，而非转向社区照护服务。其二，当疗养院床位容量饱和时，机构会缩短享受医疗补助计划患者的入住时长，以收治更多盈利性更高的自费私人付费患者。其三，相较于患者，医护机构对财务激励的响应弹性更强。因此，通过按照护周期偿付等替代性支付模式针对性调整医护机构的激励机制，在推动患者转向社区照护服务以及实现长期照护成本节约方面，较提高患者共付费用更为有效。