How do Doctors Respond to Incentives? Unintended Consequences of Paying Doctors to Reduce Costs
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چکیده
In an effort to find effective strategies for reducing healthcare costs, the Affordable Care Act has spent billions of dollars on pilot programs. In this paper, I study a Medicare pilot program in New Jersey where hospitals paid doctors bonuses for reducing the total costs of a given admission (a “bundled payment”). I identify the effects of the bonus by comparing the behavior of a given doctor who works at multiple hospitals, some of which participate in the program and others that do not. I find that doctors respond to the bonuses by changing the composition of admitted patients, and sorting healthier patients to participating hospitals–even conditional on the program’s risk-adjustment criteria. Conditional on admission and patient health, however, doctors do not reduce costs or change procedure use. That doctors can identify low-cost patients in response to payment incentives is important for policy design going forward. In addition, the gaming behavior of doctors suggests that it is problematic to extrapolate the results of this and similar pilot programs to a nationwide reform. ∗PhD Candidate, Princeton University. I thank Janet Currie, Ilyana Kuziemko, Hank Farber, Tom Vogl, Anne Case, Thomas Winberry, and participants in the Center for Health and Wellbeing and Public Finance workshops at Princeton University for helpful comments. I also thank the staff at the New Jersey Department of Health for their help accessing the data, and the Center for Health and Wellbeing for financial support.
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Do Financial Incentives Increase Doctors’ Willingness to Publish Research? – A Pilot Study of 21 Junior Doctors
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تاریخ انتشار 2016