M A Cohen1, A Tumlinson. 1. Center for Health and Long-Term Care Research, Waltham, MA, USA.
Abstract
OBJECTIVES: During the past 7 years there has been a significant increase in the use of the Medicare home health benefit. In this article, the authors document trends in the use of the benefit and develop multivariate models to identify the factors that explain state variation in its use. METHODS: To develop quantitative models, the authors collected state information on all variables for each of 3 years: 1991, 1992, and 1993. The authors chose to focus on those variables that had been found to be significant in other research as well as those that we posited would likely influence utilization. The authors tested similar sets of explanatory variables for each year of the analysis. The unit of analysis is the "state" and depending on data availability, the number of states included in the analyses range from between 46 to 49. (Arizona does not have a state Medicaid program.) RESULTS: The authors' analysis shows that interaction exists between state policies and use of the benefit. Utilization is higher in states that face greater fiscal pressure concerning their Medicaid budgets; the lack of state personal care programs increases Medicare use, and, when Medicaid home health expenditures decline, the number of Medicare home health care users increases. There is also an inverse relationship between the number of long-term care and skilled nursing facilities in a state and the use of the benefit. Thus, for some, the benefit serves as a substitute for long-term care needs and, for others, for postacute care needs. CONCLUSIONS: The overlap between the population served and the services provided by state programs and Medicare has given states and providers an opportunity to leverage Federal dollars in lieu of state program dollars. As the Federal government attempts to control expenditure growth, policy-makers must be mindful of how state actions can influence the level and type of Federal expenditure.
OBJECTIVES: During the past 7 years there has been a significant increase in the use of the Medicare home health benefit. In this article, the authors document trends in the use of the benefit and develop multivariate models to identify the factors that explain state variation in its use. METHODS: To develop quantitative models, the authors collected state information on all variables for each of 3 years: 1991, 1992, and 1993. The authors chose to focus on those variables that had been found to be significant in other research as well as those that we posited would likely influence utilization. The authors tested similar sets of explanatory variables for each year of the analysis. The unit of analysis is the "state" and depending on data availability, the number of states included in the analyses range from between 46 to 49. (Arizona does not have a state Medicaid program.) RESULTS: The authors' analysis shows that interaction exists between state policies and use of the benefit. Utilization is higher in states that face greater fiscal pressure concerning their Medicaid budgets; the lack of state personal care programs increases Medicare use, and, when Medicaid home health expenditures decline, the number of Medicare home health care users increases. There is also an inverse relationship between the number of long-term care and skilled nursing facilities in a state and the use of the benefit. Thus, for some, the benefit serves as a substitute for long-term care needs and, for others, for postacute care needs. CONCLUSIONS: The overlap between the population served and the services provided by state programs and Medicare has given states and providers an opportunity to leverage Federal dollars in lieu of state program dollars. As the Federal government attempts to control expenditure growth, policy-makers must be mindful of how state actions can influence the level and type of Federal expenditure.
Authors: Melinda Beeuwkes Buntin; Anita Datar Garten; Susan Paddock; Debra Saliba; Mark Totten; José J Escarce Journal: Health Serv Res Date: 2005-04 Impact factor: 3.402
Authors: Guofen Yan; Alfred K Cheung; Tom Greene; Alison J Yu; M Norman Oliver; Wei Yu; Jennie Z Ma; Keith C Norris Journal: Clin J Am Soc Nephrol Date: 2015-10-08 Impact factor: 8.237
Authors: Seby John; Nicolas R Thompson; Terry Lesko; Nancy Papesh; Nancy Obuchowski; Dan Tomic; Dolora Wisco; Zeshaun Khawaja; Ken Uchino; Shumei Man; Esteban Cheng-Ching; Gabor Toth; Thomas Masaryk; Paul Ruggieri; Michael Modic; Muhammad Shazam Hussain Journal: Interv Neurol Date: 2017-05-05