The Impact Of Medicare's Rural Add-On Payments On Supply Of Home Health Agencies Serving Rural Counties
The Impact Of Medicare's Rural Add-On Payments On Supply Of Home Health Agencies Serving Rural Counties
复制标题
医疗保险农村附加支付对服务于农村地区的居家医疗机构供应的影响
DOI：
10.1377/hlthaff.2019.00952
复制
发表时间：
2020-06-01
期刊：
影响因子：
9.7
通讯作者：
Frogner, Bianca K.
中科院分区：
文献类型：
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作者：
Mroz, Tracy M.;Patterson, Davis G.;Frogner, Bianca K.
自2001年以来，医疗保险制度断断续续地向为农村受益人服务的家庭保健机构提供了比标准付款高出一定百分比的增加额。然而，农村附加付款对服务农村社区的家庭保健机构供应的影响尚不清楚。利用伪自然实验的优势，通过改变农村附加支付金额随着时间的推移，我们使用家庭健康比较的数据来研究支付如何影响服务于农村县的家庭健康机构的数量。我们的研究结果表明，虽然供应变化是类似的农村县毗邻城市地区和城市县，无论附加支付，只有更高的附加支付（5%或10%）保持供应变化的农村县不毗邻城市地区的步伐在城市县。我们的研究结果支持了最近从广泛应用到有针对性的农村附加支付的转变，但提出了这些支付的金额和最终日落对服务于偏远农村社区的家庭卫生机构供应的影响的问题。
Intermittently since 2001, Medicare has provided a percentage increase over standard payments to home health agencies that serve rural beneficiaries. Yet the effect of rural add-on payments on the supply of home health agencies that serve rural communities is unknown. Taking advantage of the pseudo-natural experiment created by varying rural addon payment amounts over time, we used data from Home Health Compare to examine how the payments affected the number of home health agencies serving rural counties. Our results suggest that while supply changes are similar in rural counties adjacent to urban areas and in urban counties regardless of add-on payments, only higher add-on payments (of 5 percent or 10 percent) keep supply changes in rural counties not adjacent to urban areas on pace with those in urban counties. Our findings support the recent shift from broadly applied to targeted rural add-on payments but raise questions about the effects of the amount and eventual sunset of these payments on the supply of home health agencies serving remote rural communities.