Swan J H, Harrington C, Pickard R B
Department of Public Health Sciences, Wichita State University, Wichita, KS 67260-0152, USA.
J Health Soc Policy. 2001;12(4):53-73. doi: 10.1300/J045v12n04_04.
Medicaid nursing home reimbursement methods and per diem rates affect costs, quality, equity, and access. State rate-setting is a laboratory of policymaking, which can inform state and federal Medicaid reform initiatives. This paper explains state Medicaid nursing facility rates in 1979-1994. Findings suggest that prospective facility-specific methods constrained rates in some but not all periods, particularly when older cost-reports were employed in rate-setting. Analysis failed to show that prospective class rate-setting methods constrained rate increases. Findings suggest that the efficacy of reimbursement methodology to control rates depends upon wider health care policy trends and that future facility-level analyses should consider policy contexts as between states.
医疗补助养老院报销方法和每日费用率会影响成本、质量、公平性和可及性。州费率设定是一个政策制定的试验场，可为州和联邦医疗补助改革举措提供参考。本文解释了1979年至1994年期间各州医疗补助护理机构的费率。研究结果表明，针对特定机构的前瞻性方法在某些时期（但并非所有时期）限制了费率，尤其是在费率设定中采用较旧成本报告时。分析未能表明前瞻性分类费率设定方法限制了费率增长。研究结果表明，报销方法控制费率的效果取决于更广泛的医疗保健政策趋势，并且未来针对机构层面的分析应考虑各州之间的政策背景。
