Cotterill Philip G, Gage Barbara J
Centers for Medicare & Medicaid Services, Office of Research, Development, and Information, 7500 Security Boulevard, C3-21-28, Baltimore, MD 21244-1850, USA.
Health Care Financ Rev. 2002 Winter;24(2):1-6.
The Balanced Budget Act (BBA) of 1997 contained the most sweeping changes in payment policy for Medicare post-acute care (PAC) services ever enacted in a single piece of legislation. Research on the early impacts of these changes is now beginning to appear, and this issue of the includes six articles covering a range of timely PAC issues. There are two articles on skilled nursing facility (SNF) care—the first by Chapin White, Steven D. Pizer, and Alan J. White and the second by Kathleen Dalton and Hilda A. Howard. These are followed by two articles on home health care by Harriet Komisar and Nelda McCall, Jodi Korb, Andrew Petersons, and Stanley Moore. The next article in this issue by Susan E. Bronskill, Sharon-Lise T. Normand, and Barbara J. McNeil examines PAC use for Medicare patients following acute myocardial infarction. The last article by Jerry Cromwell, Suzanne Donoghue, and Boyd H. Gilman considers methodological issues in expanding Medicare's definition of transfers from acute hospitals to include transfers to PAC settings. To help the reader understand the impacts of the BBA changes in payment policy, we present data on Medicare utilization trends from 1994-2000 for short-stay inpatient hospital care and each of the major PAC services—SNF, home health, inpatient rehabilitation, and long-term care hospital (Figures 1 and 2). Utilization is measured as the volume of services (days of care for the institutional settings and visits for home health) per 1,000 Medicare beneficiaries. Medicare managed care enrollees and their service utilization are excluded.
1997年的《平衡预算法案》（BBA）对医疗保险急性后护理（PAC）服务的支付政策做出了单项立法中最为全面的变革。关于这些变革早期影响的研究现已开始出现，本期《[期刊名称未给出]》包含六篇文章，涵盖了一系列及时的PAC问题。有两篇关于熟练护理设施（SNF）护理的文章——第一篇由查平·怀特、史蒂文·D·皮泽和艾伦·J·怀特撰写，第二篇由凯瑟琳·道尔顿和希尔达·A·霍华德撰写。随后是哈丽雅特·科米萨尔、内尔达·麦考尔、乔迪·科尔布、安德鲁·彼得森斯和斯坦利·摩尔撰写的两篇关于家庭医疗保健的文章。本期的下一篇文章由苏珊·E·布朗斯基尔、莎伦 - 莉丝·T·诺曼德和芭芭拉·J·麦克尼尔撰写，探讨了急性心肌梗死后医疗保险患者的PAC使用情况。最后一篇文章由杰里·克伦威尔、苏珊娜·多诺霍和博伊德·H·吉尔曼撰写，考虑了在扩大医疗保险从急性医院转出定义以纳入向PAC机构转出方面的方法学问题。为帮助读者理解BBA支付政策变革的影响，我们展示了1994 - 2000年医疗保险在短期住院医院护理以及各主要PAC服务——SNF、家庭医疗、住院康复和长期护理医院方面的使用趋势数据（图1和图2）。使用量以每1000名医疗保险受益人的服务量（机构环境下的护理天数和家庭医疗的就诊次数）来衡量。医疗保险管理式护理参保者及其服务使用情况被排除在外。
