Grabowski David C
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 35294-0022, USA.
Inquiry. 2002 Fall;39(3):258-78. doi: 10.5034/inquiryjrnl_39.3.258.
In recent years, there has been large growth in the nursing home industry in the use of case-mix adjusted Medicaid payment systems that employ resident characteristics to predict the relative use of resources in setting payment levels. Little attention has been paid to the access and quality incentives that these systems provide in the presence of excess demand conditions due to certificate-of-need (CON) and construction moratoria. Using 1991 to 1998 panel data for all certified U.S. nursing homes, a fixed-effects model indicates that adoption of a case-mix payment system led to increased access for more dependent residents, but the effect was modified in excess demand markets. Quality remained relatively stable with the introduction of case-mix reimbursement, regardless of the presence of excess demand conditions. These results suggest that CON and construction moratoria are still important barriers within the nursing home market, and recent quality assurance activities related to the introduction of case-mix payment systems may have been effective.
近年来，疗养院行业在使用病例组合调整后的医疗补助支付系统方面有了大幅增长，这些系统利用居民特征来预测设定支付水平时资源的相对使用情况。由于需要证书（CON）和暂停建设，在存在过度需求的情况下，这些系统所提供的准入和质量激励措施很少受到关注。利用1991年至1998年美国所有认证疗养院的面板数据，一个固定效应模型表明，采用病例组合支付系统导致更多依赖护理的居民获得了更多的服务，但在过度需求市场中，这种效果有所改变。无论是否存在过度需求情况，随着病例组合报销的引入，质量保持相对稳定。这些结果表明，需要证书和暂停建设仍然是疗养院市场中的重要障碍，最近与引入病例组合支付系统相关的质量保证活动可能已经取得了成效。
