Working Paper: NBER ID: w17419
Authors: Guy David; Evan Rawley; Daniel Polsky
Abstract: We develop a formal model to show how integration solves task allocation problems between organizations and test the predictions of the model, using a large and rich patient-level dataset on hospital discharges to nursing homes and home health care. As predicted by the theory, we find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower cost delivery systems by discharging patients earlier and in poorer health, and integration leads to greater post-hospitalization service intensity. While integration facilitates a shift in the allocation of tasks, health outcomes are no worse when patients receive care from an integrated provider. The evidence suggests that by improving the allocation of tasks, integration solves coordination problems that arise in market exchange.
Keywords: Vertical Integration; Task Allocation; Healthcare Economics; Patient Care
JEL Codes: I12; L23
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Vertical Integration (L22) | Earlier Discharges of Patients in Poorer Health (I14) |
| Vertical Integration (L22) | Greater Intensity of Post-Hospitalization Services (I11) |
| Earlier Discharges of Patients in Poorer Health (I14) | No Deterioration in Health Outcomes (I14) |
| Vertical Integration (L22) | Efficient Care Delivery (I11) |