The Differential Impact of Medicare Home Health Care Policy on Impaired Beneficiaries
The Differential Impact of Medicare Home Health Care Policy on Impaired Beneficiaries
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DOI：
10.1080/15588740801909911
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发表时间：
2008-01-01
期刊：
影响因子：
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通讯作者：
Marcus, Steven C.
中科院分区：
文献类型：
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作者：
Davitt, Joan K.;Marcus, Steven C.
1997年的平衡预算法案（BBA'97）大大减少了医疗保险家庭健康计划的报销。BBA'97的第一阶段，即临时支付系统，将偿还额削减到1993年的水平，并建立了新的资本化偿还。为了确定这些变化对患者损伤和家庭护理使用之间关系的潜在调节作用，我们比较了1996年和1998年医疗保险当前受益人调查数据。使用多变量回归控制健康/功能，易感性和使能特性，我们证明了显着减少家庭健康使用后IPS与ADL，健康和记忆障碍的人。IPS鼓励各机构削减对更多受损患者的服务，这些患者可能会耗尽每个受益人的上限。其他卫生系统也可采取类似的政策。因此，必须了解全面变革对弱势群体的不同影响。
The Balanced Budget Act of 1997 (BBA'97) dramatically decreased reimbursements in the Medicare home health program. The first phase of BBA'97, the Interim Payment System (IPS), slashed reimbursements to 1993 levels and established a new capitated reimbursement. To identify potential moderating influences of these changes on the relationship between patient impairment and home care use, we compared 1996 and 1998 Medicare Current Beneficiary Survey data. Using multivariate regressions controlling for health/functional, predisposing and enabling characteristics, we demonstrate dramatic decreases in home health use post IPS by persons with ADL, health, and memory impairments. The IPS encouraged agencies to cut services to more impaired patients who might exhaust the per- beneficiary cap. Similar policies may be adopted for other health systems. Thus, it is critical to understand the differential impact of sweeping changes on vulnerable populations.