Long-term care service mix in the Veterans Health Administration after home care expansion.
Long-term care service mix in the Veterans Health Administration after home care expansion.
复制标题
家庭护理扩展后，退伍军人健康管理局的长期护理服务组合。
DOI：
10.1111/1475-6773.13687
复制
发表时间：
2021
影响因子：
3.4
通讯作者：
VanHoutven,CourtneyH
中科院分区：
文献类型：
--
作者：
Jacobs,JosephineC;Wagner,ToddH;Trivedi,Ranak;Lorenz,Karl;VanHoutven,CourtneyH
目的确定退伍军人健康管理局（VHA）在2001年《千年法案》之后为扩大家庭和社区服务（HCBS）的覆盖范围所做的努力是否显着改变了退伍军人对机构性付费住宅的利用，和无偿家庭护理相对于非VHA用户医疗保险人口，没有接触到HCBS扩展工作。数据来源我们使用健康和退休研究和VHA行政之间的联系研究设计我们使用粗化精确匹配进行了一项回顾性匹配队列研究，以确保VHA使用者（n= 943）和非使用者（n= 6106）的可观察特征平衡。我们使用了一个人的固定效应estimator.Data收集/提取MethodsIndividuals的差异中的差异的方法是有资格纳入分析，如果他们是65岁或以上，并表明他们是由医疗保险在1998年。如果个人在基线时被医疗补助保险所覆盖，则被排除在外。个人被认为暴露于VHA HCBS扩展努力，如果他们在VHA注册并使用VHA服务。主要发现理论预测，增加公共分配的HCBS将减少其替代品的利用（例如，机构照料和无报酬的照料）。我们发现，在《千年法案》通过后，VHA使用者和非使用者之间在使用机构长期护理的概率（0.7%，95% CI：-0.009，0.022）或接受日常生活活动的有偿帮助的概率（0.06%，95% CI：-0.011，0.0125）方面没有观察到差异。VHA用户获得更多的时间后千禧年法案（1.48，95% CI：-0.232，3.187）的无偿护理，虽然这种效果并不显着，一旦我们引入了控制心理health.ConclusionsOur研究结果表明，强制访问HCBS服务并不一定意味着访问这些服务将效仿。
ObjectiveTo determine whether the Veterans Health Administration's (VHA) efforts to expand access to home‐ and community‐based services (HCBS) after the 2001 Millennium Act significantly changed Veterans' utilization of institutional, paid home, and unpaid home care relative to a non‐VHA user Medicare population that was not exposed to HCBS expansion efforts.Data SourcesWe used linkages between the Health and Retirement Study and VHA administrative data from 1998 until 2012.Study DesignWe conducted a retrospective‐matched cohort study using coarsened exact matching to ensure balance on observable characteristics for VHA users (n= 943) and nonusers (n= 6106). We used a difference‐in‐differences approach with a person fixed‐effects estimator.Data Collection/Extraction MethodsIndividuals were eligible for inclusion in the analysis if they were age 65 or older and indicated that they were covered by Medicare insurance in 1998. Individuals were excluded if they were covered by Medicaid insurance at baseline. Individuals were considered exposed to VHA HCBS expansion efforts if they were enrolled in the VHA and used VHA services.Principal FindingsTheory predicts that an increase in the public allocation of HCBS will decrease the utilization of its substitutes (e.g., institutional care and unpaid caregiving). We found that after the Millennium Act was passed, there were no observed differences between VHA users and nonusers in the probability of using institutional long‐term care (0.7% points, 95% CI: −0.009, 0.022) or in receiving paid help with activities of daily living (0.06% points, 95% CI: −0.011, 0.0125). VHA users received more hours of unpaid care post‐Millennium Act (1.48, 95% CI: −0.232, 3.187), though this effect was not significant once we introduced controls for mental health.ConclusionsOur findings indicate that mandating access to HCBS services does not necessarily imply that access to these services will follow suit.