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Effects of Episode-Based Payment on Health Care Spending and Utilization: Evidence from Perinatal Care in Arkansas / Caitlin Carroll, Michael Chernew, A. Mark Fendrick, Joe Thompson, Sherri Rose.
- Format:
- Book
- Author/Creator:
- Carroll, Caitlin.
- Series:
- Working Paper Series (National Bureau of Economic Research) no. w23926.
- NBER working paper series no. w23926
- Language:
- English
- Physical Description:
- 1 online resource: illustrations (black and white);
- Other Title:
- Effects of Episode-Based Payment on Health Care Spending and Utilization
- Place of Publication:
- Cambridge, Mass. National Bureau of Economic Research 2017.
- Summary:
- We study how physicians respond to financial incentives imposed by episode-based bundled payment (EBP), which encourages lower spending and improved quality for an entire episode of care. Specifically, we study the impact of the Arkansas Health Care Payment Improvement Initiative, a multi-payer program that requires providers in the state to enter into EBP arrangements for perinatal care. Because of its multi-payer nature and the requirement that providers participate, the program covers the vast majority of births in the state. Unlike fee-for-service reimbursement, EBP holds physicians responsible for all care within a discrete clinical episode, rewarding physicians not only for efficient use of their own services but also for efficient management of other health care inputs. In a difference-in-differences analysis of commercial claims, we find that perinatal spending decreased by 3.8% overall in Arkansas after the introduction of EBP, compared to surrounding states. We find that the decrease was driven by reduced spending on non-physician health care inputs, specifically the prices paid for inpatient facility care, and that our results are robust to a number of sensitivity and placebo tests. We additionally find that EBP was associated with a limited improvement in quality of care.
- Notes:
- Print version record
- October 2017.
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