THE IMPACT OF MEDICARE'S PROSPECTIVE PAYMENT SYSTEM ON HOME HEALTH AGENCIES: A "THIRD GENERATION" STUDY IN POLICY IMPLEMENTATION (HEALTH POLICY).
Contributors: University of Georgia.
Published: 1991
Number of pages: 308
Subjects: Political Science, Public Administration.; Sociology, Public and Social Welfare.; Gerontology.; Health Sciences, Public Health.; Health Sciences, Nursing.
Description: The purpose of this study was to measure the influence of the Medicare Prospective Payment System, implemented on October l, 1983, on four types of nonprofit home health agencies in Georgia. Medicare used the Prospective Payment System (PPS) to control inpatient hospital care costs. A fee schedule, established through diagnosis related groups (DRGs), was soon linked to shorter lengths of stay in the hospital. Home health agencies reported concurrent increases in demands for their services.

A qualitative historical examination of government documents and other literature was used to describe social, economic, and public administration influences on Medicare and the four phase implementation of PPS. Government analysts and social welfare scholars link PPS to a variety of implementation gaps and spillover effects, particularly in home care services. However, the qualitative analysis illustrates a dearth of studies to measure the influence of PPS on home health care. The only study in the literature examines PPS influence on home care agencies in public health departments.

Two quantitative approaches were used to measure the impact of PPS in Georgia. Two data sets were collected from the records of four non-profit home health agencies in three areas of Georgia. Eight hundred randomly selected client records were examined to determine PPS influences on individual client profiles. Total Medicare admissions and total Medicare home visits were submitted to time series analysis. Both data sets compared pre-PPS and post-PPS periods, a period from January 1, 1982, through December 31, 1986.

Analysis of variance testing and multiple classification analysis of the random sample demonstrated that PPS is linked to changes in length of home care service and numbers of visits in several categories. Time series analysis demonstrates changes in both admission rates and home visit rates. Changes were measured at a significance level of 0.05 probability.

Analysis suggests that increased denials and government reliance on private agencies to administer service reimbursement are future research issues. More sophisticated quantitative analysis of health policy implementation is needed prior to future health policy decisions.
Notes: Source: Dissertation Abstracts International, Volume: 52-06, Section: A, page: 2270.

Thesis (D.P.A.)--UNIVERSITY OF GEORGIA, 1991.

School code: 0077.