For-Profit Medicare Home Health Agencies' Costs Appear Higher And Quality Appears Lower Compared To Nonprofit Agencies
For-Profit Medicare Home Health Agencies' Costs Appear Higher And Quality Appears Lower Compared To Nonprofit Agencies
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DOI：
10.1377/hlthaff.2014.0307
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发表时间：
2014-08-01
期刊：
影响因子：
9.7
通讯作者：
Woolhandler, Steffie
中科院分区：
文献类型：
--
作者：
Cabin, William;Himmelstein, David U.;Woolhandler, Steffie
营利性或专有家庭健康机构在 1980 年之前一直被禁止参与 Medicare，但现在它们占提供此类服务的机构的大多数。自 2000 年实施基于风险的预期支付系统以来，医疗保险家庭健康成本迅速增长。我们分析了最近的国家成本和病例组合调整后的质量结果，以评估营利性和非营利性家庭健康机构的绩效。与非营利组织相比，营利性机构在整体质量指标上的得分稍差，但明显较差（分别为 77.18% 和 78.71%）。值得注意的是，营利性机构在临床重要结果“避免住院”方面的得分低于非营利性机构（71.64% 和 73.53%）。在营利性企业占主导地位的南方地区，质量指标得分最低。与非营利组织相比，专有机构的每位患者成本更高（4,827 美元对 4,075 美元），利润更高，管理成本也更高。我们的研究结果引起了人们的担忧，即营利性机构是否应继续有资格获得医疗保险付款，以及医疗保险以市场为导向、基于风险的家庭护理支付系统的效率。
For-profit, or proprietary, home health agencies were banned from Medicare until 1980 but now account for a majority of the agencies that provide such services. Medicare home health costs have grown rapidly since the implementation of a risk-based prospective payment system in 2000. We analyzed recent national cost and case-mix-adjusted quality outcomes to assess the performance of for-profit and nonprofit home health agencies. For-profit agencies scored slightly but significantly worse on overall quality indicators compared to nonprofits (77.18 percent and 78.71 percent, respectively). Notably, for-profit agencies scored lower than nonprofits on the clinically important outcome "avoidance of hospitalization" (71.64 percent versus 73.53 percent). Scores on quality measures were lowest in the South, where for-profits predominate. Compared to nonprofits, proprietary agencies also had higher costs per patient ($4,827 versus $4,075), were more profitable, and had higher administrative costs. Our findings raise concerns about whether for-profit agencies should continue to be eligible for Medicare payments and about the efficiency of Medicare's market-oriented, risk-based home care payment system.