Kitchener Martin, Carrillo Helen, Harrington Charlene
Department of Social and Behavioral Sciences, University of California, San Francisco, 94118, USA.
Inquiry. 2003 Winter;40(4):375-89. doi: 10.5034/inquiryjrnl_40.4.375.
As states face challenges posed by budget crises and pressures to develop Medicaid home and community-based services (HCBS), this paper provides a longitudinal analysis of state variation in expenditures and utilization for three HCBS programs (waivers, home health and personal care), and for total Medicaid HCBS. The first part of the analysis describes the nature and scope of state variation for each program in 1999, using such measures as participants per 1,000 population and expenditures per capita. The second part of the analysis presents time-series regression models that estimate sociodemographic, state policy, and market factors associated with intra-state variation in waiver participants and expenditures, and home health, personal care and total HCBS expenditures for the period 1992-99. Among the results, positive state-level factors related to HCBS participants and expenditures include: higher percentages of aged people, greater incomes per capita, and a larger supply of home health agencies.
随着各州面临预算危机带来的挑战以及发展医疗补助居家和社区服务（HCBS）的压力，本文对三个HCBS项目（豁免项目、居家健康服务和个人护理服务）以及医疗补助HCBS总支出和利用率的州际差异进行了纵向分析。分析的第一部分描述了1999年每个项目州际差异的性质和范围，使用了每千人口参与者数量和人均支出等指标。分析的第二部分呈现了时间序列回归模型，这些模型估计了与1992 - 1999年期间豁免项目参与者和支出以及居家健康服务、个人护理服务和HCBS总支出的州内差异相关的社会人口、州政策和市场因素。在研究结果中，与HCBS参与者和支出相关的积极的州级因素包括：老年人口比例较高、人均收入较高以及居家健康机构供应较多。
