Econ Papers Daily / 工作论文
养老院中的选择性收治：来自随机审计研究的证据
Selective Admissions in Nursing Homes: Evidence from a Randomized Audit Study
摘要
It has been widely documented that patients in the US who are associated with disadvantaged demographics receive care at lower quality nursing homes. To understand the role that selective admissions may play in contributing to this pattern, we conducted a nationwide audit study of the impact of patient race, payer, and medical condition on responses to about 5,500 availability inquiries sent to about 3,000 nursing homes. We find 10-15% lower availability for Medicaid patients compared to private-pay patients and for patients with Alzheimer’s disease compared to those without; these availability gaps generally increase with nursing home quality. We find no statistically significant evidence of differential availability by race. To quantify the implications of these selective admissions practices, we embed the audit study results in a model of constrained nursing home choice. We estimate that if, counterfactually, Medicaid patients had the same choice sets as their private-pay counterparts, they would attend higher quality nursing homes on average, but the private-Medicaid gap in quality would be reduced by only 5-10%. Our results suggest that supply-side availability differences by payer are widespread, but that they are unlikely to be the primary factor behind the observed gap in quality of nursing homes attended.
中文摘要
已有广泛文献记录，在美国，与弱势人口特征相关的患者接受的养老院护理质量较低。为了解选择性收治可能在促成这一模式中发挥的作用，我们开展了一项全国性审计研究，考察患者种族、支付方和医疗状况对约 3,000 家养老院收到的约 5,500 次可用性询问之回复的影响。我们发现，与自费患者相比，Medicaid 患者的可用性低 10-15%；与未患阿尔茨海默病的患者相比，阿尔茨海默病患者的可用性也低 10-15%；这些可用性差距通常随养老院质量提高而扩大。我们没有发现按种族存在差异化可用性的统计显著证据。为量化这些选择性收治做法的影响，我们将审计研究结果嵌入一个受约束的养老院选择模型。我们估计，如果反事实地让 Medicaid 患者拥有与自费患者相同的选择集，他们平均会入住质量更高的养老院，但自费—Medicaid 质量差距只会缩小 5-10%。我们的结果表明，按支付方划分的供给侧可用性差异普遍存在，但它们不太可能是所观察到的养老院护理质量差距的主要因素。