Higher levels of state funding for Home- and Community-Based Services linked to better state performances in Long-Term Services and Supports.
Higher levels of state funding for Home- and Community-Based Services linked to better state performances in Long-Term Services and Supports.
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国家对家庭和社区服务的资助水平越高，国家在长期服务和支持方面的表现越好。
DOI：
10.1111/1475-6773.14288
复制
发表时间：
2024
影响因子：
3.4
通讯作者：
Li,Yue
中科院分区：
文献类型：
--
作者：
Cheng,Zijing;Mutoniwase,Espérance;Cai,Xueya;Li,Yue
目的探讨家庭和社区服务（HCBS）的国家资助水平与长期服务和支持（LTSS）中国家整体和特定维度绩效之间的关系。数据来源和研究设置我们采用了来自Medicaid LTSS年度支出报告、美国退休人员协会（AARP）国家记分卡、美国人口普查和联邦储备经济数据的国家级二级数据，研究设计总体州LTSS排名，沿着维度特定排名，分别针对州医疗补助在HCBS上的支出相对于LTSS上的总医疗补助支出进行建模。所有模型进行了调整，为国家协变量，长期趋势，和状态固定effects.Data Collection/Extraction MethodsThe研究样本包括所有50个州和哥伦比亚特区。然而，由于医疗补助HCBS支出的数据缺失，加州、特拉华州、伊利诺伊州和弗吉尼亚州被排除在2019财年之外。主要发现医疗补助LTSS支出占HCBS的比例每增加10个百分点，医疗补助LTSS支出占HCBS的比例就增加2.05个百分点。（95%置信区间[CI]：-3.88至0.22，p = 0.03）在国家整体LTSS系统性能的排名中，提高了2.92分（95%CI：-4.87至0.98，p < 0.01），以及1.73分（95%CI：−3.14 to 0.32，p = 0.02）排名改善的维度Effective Transitions.ConclusionsOur study suggested promising effects of increased state funding for HCBS on LTSS performance.
ObjectiveTo examine the relationship between the level of state funding for Home‐ and Community‐Based Services (HCBS) and state overall and dimension‐specific performances in Long‐Term Services and Supports (LTSS).Data Sources and Study SettingWe employed state‐level secondary data from the Medicaid LTSS Annual Expenditures Reports, the American Association of Retired Persons (AARP) State Scorecards, the U.S. Census, and Federal Reserve Economic data, spanning the timeframe of 2010–2020.Study DesignOverall state LTSS rankings, along with dimension‐specific rankings, were modeled separately against state Medicaid spending on HCBS relative to total Medicaid spending on LTSS. All models were adjusted for state covariates, secular trend, and state fixed effects.Data Collection/Extraction MethodsThe study sample included all 50 states and the District of Columbia. However, California, Delaware, Illinois, and Virginia were excluded from FY2019 due to missing data on Medicaid HCBS expenditures.Principal FindingsEvery 10 percentage‐point increase in the proportion of Medicaid LTSS spending to HCBS demonstrated 2.05 points improvement (95% confidence interval [CI]: −3.88 to 0.22,p= 0.03) in rankings for state overall LTSS system performance, 2.92 points improvement (95% CI: −4.87 to 0.98,p< 0.01) in rankings for the Choice of Setting and Provider dimension, as well as 1.73 points (95% CI: −3.14 to 0.32,p= 0.02) ranking improvement in the dimension of Effective Transitions.ConclusionsOur study suggested promising effects of increased state funding for HCBS on LTSS performance.
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