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An Evidence-Based Incentive System for Medicare's End-Stage Renal Disease Program

出版	SSRN, 2020
URL	http://books.google.com.hk/books?id=OG3jzwEACAAJ&hl=&source=gbs_api

註釋Recent legislations directed Medicare to revamp its decades-old system for reimbursing dialysis treatments, with focus on the risk adjustment of payments and on the transition toward a pay-for-compliance system. To design an optimal payment system that incorporates these features, we develop an empirical method to estimate the structural parameters of the principal-agent model underlying Medicare's dialysis payment system. We use the model and parameter estimates to answer the following questions: Can a pay-for-compliance system based only on the intermediate performance measures currently identified by Medicare achieve first-best? How should patient outcomes be risk adjusted, and what welfare gains can be achieved by doing so? Our main findings are as follows: 1) the current set of intermediate measures identified by Medicare are not comprehensive enough for use alone in a pay-for-compliance system; 2) paying for risk-adjusted downstream outcomes instead of raw downstream outcomes can lengthen the hospital-free life of admitted patients by two weeks per patient per year without increasing Medicare expenditures.