Provider responses to discontinuous tariffs: evidence from Dutch rehabilitation care
Tóm tắt
Abrupt jumps in reimbursement tariffs have been shown to lead to unintended effects in physicians’ behavior. A sudden change in tariffs at a pre-defined point in the treatment can incentivize health care providers to prolong treatment to reach the higher tariff, and then to discharge patients once the higher tariff is reached. The Dutch reimbursement schedule in hospital rehabilitation care follows a two-threshold stepwise-function based on treatment duration. We investigated the prevalence of strategic discharges around the first threshold and assessed whether their share varies by provider type. Our findings suggest moderate response to incentives by traditional care providers (general and academic hospitals, rehabilitation centers and multicategorical providers), and strong response by profit-oriented independent treatment centers. When examining the variation in response based on the financial position of the organization, we found a higher probability of manipulation among providers in financial distress. Our findings provide multiple insights and possible indicators to identify provider types that may be more prone to strategic behavior.
Tài liệu tham khảo
Coulam, R. F., & Gaumer, G. L. (1992). Medicare’s prospective payment system: A critical appraisal. Health Care Financing Review, 1991(Suppl), 45–77.
Douven, R., Remmerswaal, M., & Mosca, I. (2015). Unintended effects of reimbursement schedules in mental health care. Journal of Health Economics 42, 139–150.
Einav, L., Finkelstein, A., & Mahoney, N. (2018). Provider incentives and healthcare costs: Evidence from long-term care hospitals. Econometrica, 86(6), 2161–2219. https://doi.org/10.3982/ecta15022
Eliason, P. J., Grieco, P. L. E., McDevitt, R. C., & Roberts, J. W. (2018). Strategic patient discharge: The case of long-term care hospitals. American Economic Review, 108(11), 3232–3265. https://doi.org/10.1257/aer.20170092
Ellis, R. P., & McGuire, T. G. (1986). Provider behavior under prospective reimbursement, cost sharing and supply. Journal of Health Economics, 5(1), 129–151.
Jürges, H., & Köberlein, J. (2015). What explains DRG upcoding in neonatology? The roles of financial incentives and infant health. Journal of Health Economics, 43, 13–26. https://doi.org/10.1016/j.jhealeco.2015.06.001
Kleven, H. J. (2016). Bunching. Annual Review of Economics, 8(1), 435–464. https://doi.org/10.1146/annurev-economics-080315-015234
Kroneman, M., Boerma, W., van den Berg, M., Groenewegen, P., de Jong, J., & van Ginneken, E. (2016). Netherlands: Health system review. Health Systems in Transition, 18(2), 1–240.
Krug, E., & Cieza, A. (2019). Strengthening health systems to provide rehabilitation services. Neuropsychological Rehabilitation, 29(5), 672–674. https://doi.org/10.1080/09602011.2017.1319391
Kuijper, K. (2018). ‘Vergoeding niet-gecontracteerde zorg onduidelijk’. zorgwijzer.nl. https://www.zorgwijzer.nl/zorgverzekering-2019/vergoeding-niet-gecontracteerde-zorg-onduidelijk
McGuire, T. G. (2000). Physician agency. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of health economics (Vol. 1, pp. 461–536). Elsevier.
Rauch, A., Negrini, S., & Cieza, A. (2019). Toward Strengthening rehabilitation in health systems: Methods used to develop a WHO package of rehabilitation interventions. Archives of Physical Medicine and Rehabilitation, 100(11), 2205–2211. https://doi.org/10.1016/j.apmr.2019.06.002
Reif, S., Wichert, S., & Wuppermann, A. (2018). Is it good to be too light? Birth weight thresholds in hospital reimbursement systems. Journal of Health Economics, 59, 1–25. https://doi.org/10.1016/j.jhealeco.2018.01.007
Revalidatie Nederland. (2017). Revalidatie in 2030: Hoe revalidatie patienten in de toekomst? Retrieved from
Silverman, E., & Skinner, J. (2004). Medicare upcoding and hospital ownership. Journal of Health Economics, 23(2), 369–389. https://doi.org/10.1016/j.jhealeco.2003.09.007
SiRM en Finance Ideas onderzoek naar uitkeren van dividend in de zorg naar Tweede Kamer gestuurd. (2019). Retrieved from The Hague: https://www.sirm.nl/nieuws/si-rm-en-finance-ideas-onderzoek-naar-uitkeren-van-dividend-in-de-zorg-naar-tweede-kamer-gestuurd
Skipr. (2014, 05–19–2014). Snellere DBC´s geven ziekenhuis grip. Retrieved from https://www.skipr.nl/nieuws/snellere-dbcs-geven-ziekenhuis-grip/
Skipr. (2019). Helft revalidatiecentra schrijft rode cijfers. Skipr.nl. Retrieved from https://www.skipr.nl/nieuws/helft-revalidatiecentra-schrijft-rode-cijfers/
Vektis Intelligence. (2018). Inzicht in het overstapseizoen. Retrieved from
Wilman, S. (2020). Crisis brengt revalidatie-instellingen in financiële nood. Skipr.nl.