Konetzka R Tamara, Norton Edward C, Stearns Sally C
Department of Health Studies, University of Chicago, 5841 S. Maryland Ave., MC2007, Chicago, IL 60637, USA.
Int J Health Care Finance Econ. 2006 Sep;6(3):173-89. doi: 10.1007/s10754-006-9000-9. Epub 2006 Oct 3.
The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities, providing a natural experiment in nursing home behavior. Medicare payment policy (directed at short-stay residents) may have affected outcomes for long-stay, chronic-care residents if services for these residents were subsidized through cost-shifting prior to implementation of Medicare prospective payment for nursing homes. We link changes in both the form and level of Medicare payment at the facility level with changes in resident-level quality, as represented by pressure sores and urinary tract infections in Minimum Data Set (MDS) assessments. Results show that long-stay residents experienced increased adverse outcomes with the elimination of Medicare cost reimbursement.
1997年的《平衡预算法案》极大地改变了医疗保险支付专业护理机构费用的方式，为研究养老院行为提供了一个自然实验。如果在医疗保险对养老院实行前瞻性支付之前，长期慢性病护理居民的服务是通过成本转移得到补贴的，那么医疗保险支付政策（针对短期居住居民）可能会影响长期居住居民的护理结果。我们将机构层面医疗保险支付形式和水平的变化与居民层面质量的变化联系起来，居民层面质量的变化以最低数据集（MDS）评估中的压疮和尿路感染来表示。结果表明，随着医疗保险成本报销的取消，长期居住居民出现了更多不良护理结果。
