Grabowski David C, Angelelli Joseph J
Department of Health Care Organization and Policy, University of Alabama at Birmingham, 35294, USA.
Health Serv Res. 2004 Aug;39(4 Pt 1):793-812. doi: 10.1111/j.1475-6773.2004.00258.x.
To examine the effect of Medicaid reimbursement rates on nursing home quality in the presence of certificate-of-need (CON) and construction moratorium laws.
DATA SOURCES/STUDY SETTING: A single cross-section of Medicaid certified nursing homes in 1999 (N = 13,736).
A multivariate regression model was used to examine the effect of Medicaid payment rates and other explanatory variables on risk-adjusted pressure ulcer incidence. The model is alternatively considered for all U.S. nursing home markets, those most restrictive markets, and those high-Medicaid homes to isolate potentially resource-poor environments.
A merged data file was constructed with resident-level information from the Minimum Data Set, facility-level information from the On-Line, Survey, Certification, and Reporting (OSCAR) system and market- and state-level information from various published sources.
In the analysis of all U.S. markets, there was a positive relationship between the Medicaid payment rate and nursing home quality. The results from this analysis imply that a 10 percent increase in Medicaid payment was associated with a 1.5 percent decrease in the incidence of risk-adjusted pressure ulcers. However, there was a limited association between Medicaid payment rates and quality in the most restrictive markets. Finally, there was a strong relationship between Medicaid payment and quality in high-Medicaid homes providing strong evidence that the level of Medicaid payment is especially important within resource poor facilities.
These findings provide support for the idea that increased Medicaid reimbursement may be an effective means toward improving nursing home quality, although CON and moratorium laws may mitigate this relationship.
研究在存在需求证明（CON）和建设暂停法律的情况下，医疗补助报销率对疗养院质量的影响。
数据来源/研究背景：1999年医疗补助认证疗养院的单一横截面数据（N = 13,736）。
使用多元回归模型来检验医疗补助支付率和其他解释变量对风险调整后的压疮发生率的影响。该模型分别针对所有美国疗养院市场、限制最严格的市场以及医疗补助较高的疗养院进行考量，以分离潜在资源匮乏的环境。
构建了一个合并数据文件，其中包含来自最低数据集的居民层面信息、来自在线调查、认证和报告（OSCAR）系统的机构层面信息以及来自各种已发表来源的市场和州层面信息。
在对所有美国市场的分析中，医疗补助支付率与疗养院质量之间存在正相关关系。该分析结果表明，医疗补助支付增加10%与风险调整后的压疮发生率降低1.5%相关。然而，在限制最严格的市场中，医疗补助支付率与质量之间的关联有限。最后，在医疗补助较高的疗养院中，医疗补助支付与质量之间存在很强的关系，有力地证明了在资源匮乏的机构中，医疗补助支付水平尤为重要。
这些发现支持了这样一种观点，即增加医疗补助报销可能是提高疗养院质量的有效手段，尽管需求证明和暂停法律可能会削弱这种关系。
