Community versus Facility-based Long-Term Care: Impact on Medicare Spending & Ser
社区与基于设施的长期护理:对医疗保险支出的影响
基本信息
- 批准号:8656264
- 负责人:
- 金额:$ 4.01万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2013
- 资助国家:美国
- 起止时间:2013-09-30 至 2015-02-28
- 项目状态:已结题
- 来源:
- 关键词:
项目摘要
DESCRIPTION (provided by applicant): Disabled Medicare beneficiaries are among the costliest to the Medicare program. In addition to their substantial healthcare needs, disabled older adults often require long-term care (LTC). LTC provides help with daily activities (e.g., bathing, eating) that can be delivered in a facility like a nursing home ("facility LTC") or in a community-setting like one's own home ("community LTC"). Though Medicare does not pay for LTC, facility LTC providers have increased access to healthcare providers and may have financial incentives to increase their residents' Medicare service use, particularly acute and post-acute care. However, it is unknown whether these incentives result in higher Medicare expenditures. The proposed research will determine whether facility LTC use increases Medicare expenditures and healthcare use for disabled older adults relative to community LTC. I will extend prior research by addressing the confounding often present due to high rates of comorbidities and other unobserved factors among facility LTC users. I will first seek to identify the independent effect of facility LTC on Medicare expenditures for acute care, physician services, and post-acute care. I will then seek to determine the effect of facility LTC on hospital
related health services utilization, including emergency department (ED) visits, hospital observation days, and hospital readmissions. Methods: First, logistic regression will identify a clinically-similar group of community residents among the older adults in the Medicare Current Beneficiary Survey from 2000-2009. Incident users of facility LTC will comprise the treatment group and clinically similar community residents will comprise the control group. Second, instrumental variables will pseudo-randomize these groups to facility LTC to further adjust for any differences in co-morbidity and acuity between the groups. Number of adult children, local supply of LTC facilities, and state spending on home-delivered meals will act as instruments. Third, seven second stage models will be constructed, most using survival-adjusted methods. Survival-adjusted models are the most meaningful measure of cost in a population with high rates of death. There will be a model for each dependent variable: acute care Medicare expenditures, physician/practitioner services Medicare expenditures, post-acute care Medicare expenditures, number of ED visits, number of hospital observation days, and likelihood of 30- day and 60-day hospital readmission. Contribution and Significance: The proposed research seeks to determine the effect of a policy-modifiable factor, LTC setting, on the healthcare expenditures for high-cost Medicare beneficiaries. This will offer policymakers evidence to incorporate into payment policies as well as healthcare interventions targeted at high-cost beneficiaries. Meanwhile, the proposed research will apply novel econometric methods (including survival-adjusted methodologies) to LTC research. This will offer other researchers interested in the healthcare costs of the disabled an example of how to apply these exciting new methods to important policy questions.
描述(由申请人提供):残疾人医疗保险受益人是医疗保险计划中最昂贵的。除了大量的医疗保健需求外,残疾老年人通常需要长期护理(LTC)。LTC为日常活动提供帮助(例如,洗澡、吃饭),其可以在如疗养院的设施(“设施LTC”)或在如个人自己的家的社区环境(“社区LTC”)中递送。虽然医疗保险不支付LTC,但设施LTC提供者增加了与医疗保健提供者的接触,并可能有经济激励措施来增加居民的医疗保险服务使用,特别是急性和急性后护理。然而,目前尚不清楚这些激励措施是否会导致更高的医疗保险支出。拟议的研究将确定设施LTC的使用是否增加了医疗保险支出和医疗保健使用的残疾老年人相对于社区LTC。我将扩展以前的研究,通过解决混杂往往存在由于高比率的合并症和其他未观察到的因素之间的设施LTC用户。我将首先寻求确定设施LTC对医疗保险支出的急性护理,医生服务和急性后护理的独立影响。然后,我将寻求确定设施长期护理对医院的影响,
相关卫生服务利用,包括急诊(艾德)就诊、住院观察日和再入院。研究方法:首先,逻辑回归将在2000-2009年的医疗保险当前受益人调查中确定老年人中临床相似的社区居民群体。设施LTC的事件用户将组成治疗组,临床相似的社区居民将组成对照组。其次,工具变量将这些组伪随机化以便于LTC,以进一步调整组间合并症和敏锐度的任何差异。成年儿童的数量,当地长期护理设施的供应,以及国家在家庭送餐方面的支出将作为工具。第三,将构建七个第二阶段模型,大多数使用生存调整方法。生存调整模型是高死亡率人群中最有意义的成本衡量标准。每个因变量都有一个模型:急性护理医疗保险支出、医生/执业者服务医疗保险支出、急性护理后医疗保险支出、艾德访视次数、住院观察天数以及30天和60天再入院的可能性。贡献与意义:拟议的研究旨在确定政策可修改因素LTC设置对高成本医疗保险受益人的医疗支出的影响。这将为政策制定者提供证据,以纳入支付政策以及针对高成本受益人的医疗保健干预措施。同时,本研究将运用新的计量经济学方法(包括生存调整方法)对长期收益率进行研究。这将为其他对残疾人医疗费用感兴趣的研究人员提供一个如何将这些令人兴奋的新方法应用于重要政策问题的例子。
项目成果
期刊论文数量(0)
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