Home care reimbursement, long-term care utilization, and health outcomes
By: Robin McKnight.
Contributors: National Bureau of Economic Research.
Series: NBER working paper series ;; working paper 10414; Working paper series (National Bureau of Economic Research : Online) ;; working paper no. 10414.
Publisher: National Bureau of Economic Research
Published: 2004
Place of publication: Cambridge, MA
Language: eng
Format: Electronic resource
Subjects: Home care services -- Prospective payment -- United States.; Medicare.; Long-term care of the sick -- United States.
Description: "Long-term care currently comprises almost 10% of national health expenditures and is projected to rise rapidly over coming decades.  A key, and relatively poorly understood, element of long-term care is home health care.  I use a substantial change in Medicare reimbursement policy, which took the form of tightly binding average per-patient reimbursement caps, to address several questions about the market for home care.  I find that the reimbursement change was associated with a large drop in the provision of home care.  This drop was concentrated among unhealthy beneficiaries, which is consistent with the incentives for patient selection inherent in the per-patient caps.  I find that the decline in home health utilization was not offset by increases in institutional long-term care or other medical care and that there were no associated adverse health consequences.  However, approximately one-quarter of the decline in Medicare spending was offset by increases in out-of-pocket expenditures for home health care, with the offset concentrated in higher income populations.  Despite the value of home health care implied by the out-of-pocket expenditures, I find that the welfare implications of the reimbursement change were ambiguous"--National Bureau of Economic Research web site.
Notes: Also available in print.
Includes bibliographical references.
Title from PDF file as viewed on 1/13/2005.
System requirements: Adobe Acrobat Reader.
Mode of access: World Wide Web.