Nyman J A
J Health Econ. 1988 Dec;7(4):393-412. doi: 10.1016/0167-6296(88)90022-7.
Many believe that nursing homes exclude heavy-care Medicaid patients because their costs exceed the Medicaid reimbursement rate. This paper tests whether this was true in New York in 1983 by calculating the marginal costs of a day of nursing home care and comparing them with the per diem Medicaid reimbursement rate. Contrary to popular beliefs, the marginal cost of the most dependent SNF patient was found to be between $9 and $12 less per patient day than the average Medicaid reimbursement rate for SNF patients. This suggests that excess demand, rather than lower-than-cost reimbursement rates, was creating the heavy-care access problem in New York in 1983. Policy solutions differ depending on the cause of the access problem. The strengths and weaknesses of the different policy solutions are compared.
许多人认为疗养院拒收重症医疗补助患者是因为他们的费用超过了医疗补助的报销率。本文通过计算疗养院一天护理的边际成本，并将其与按日计算的医疗补助报销率进行比较，来检验1983年在纽约情况是否如此。与普遍看法相反，研究发现，最依赖他人护理的熟练护理机构患者的边际成本比熟练护理机构患者的平均医疗补助报销率每天低9至12美元。这表明，在1983年的纽约，造成重症护理服务获取问题的是需求过剩，而非低于成本的报销率。政策解决方案因获取问题的成因不同而有所差异。本文对不同政策解决方案的优缺点进行了比较。
