The Long-term Impact of Medicare Payment Reductions on Patient Outcomes, by Vivian Y. Wu and Yu-Chu Shen (NBER). I blogged about this yesterday.
This study examines the long term impact of Medicare payment reductions on patient outcomes using a natural experiment – the Balance Budget Act (BBA) of 1997. We use predicted Medicare revenue changes due to BBA, with simulated BBA payment cuts as an instrument, to categorize hospitals by degrees of payment cuts (small, moderate, or large), and follow Medicare patient outcomes in these hospitals over a 11 year panel: 1995-1997 pre-BBA, 1998-2000 initial years of BBA, and 2001-2005 post-BBA years. We find that Medicare AMI mortality trends stay similar across hospitals when comparing between pre-BBA and initial-BBA periods. However, the effect became measurable in 2001-2005: hospitals facing large payment cuts saw increased mortality rates relative to that of hospitals facing small cuts in the post-BBA period (2001-2005) after controlling for their pre-BBA trends. We find support that part of the worsening AMI patient outcomes in the large-cut hospitals is explained by reductions in staffing level and operating cost following the payment cuts, and that in-hospital mortality is not affected partly due to patients being discharged earlier (shorter length-of-stay).
Does X Really Cause Y? by Bryan Dowd and Robert Town (HCFO)
Increased Price Transparency in Health Care — Challenges and Potential Effects, by Anna D. Sinaiko, and Meredith B. Rosenthal (NEJM)
Designing Transparency Systems for Medical Care Prices, by David Cutler, Ph.D., and Leemore Dafny (NEJM)
The American Family in Black and White: A Post-Racial Strategy for Improving Skills to Promote Equality, by James J. Heckman (Institute for the Study of Labor working paper)