Kenney G M, Dubay L C
Health Policy Center, Urban Institute, Washington, DC 20037.
Med Care. 1992 Jan;30(1):43-57. doi: 10.1097/00005650-199201000-00004.
This study examines the determinants of area-level variation in Medicare home health use in 1985 for the entire United States, using data from Medicare Home Health Bills, the Medicare/Medicaid Automated Certification System, the Medicare Provider Analysis and Review Files, and other sources. Weighted two-stage least squares regression was used to analyze variation in the number of home health users per 1,000 enrollees and the average number of visits received per user. The data were aggregated to the Metropolitan Statistical Area and the rural part of the state, resulting in 343 units of analysis. According to the study's results, higher proportions of Medicare enrollees use home health services in areas with fewer nursing home beds per enrollee, higher hospital discharge rates, and shorter mean lengths of stay, higher Medicare reimbursement ceilings for skilled nursing home health visits, and more home health agencies per enrollee. Other things being equal, beneficiaries in New England are 40% more likely to use home health services than their counterparts in other regions with similar climates. The average number of visits received by home health users appears to be higher in areas where there are more agencies per enrollee and a higher share of agencies that are proprietary. There also appear to be large regional differences in the number of visits received per user. Our results imply that constrained access to nursing home beds is leading to higher levels of Medicare home health use and that there may be further savings from the substitution of home health services for hospital days. The study shows that Medicare reimbursement ceilings may constrain use and that access may be a problem for beneficiaries in areas with fewer agencies per enrollee. This study also points to significant regional variation in the proportion of beneficiaries who use home health services, even with controls for many different explanatory variables. Overall, our results suggest the possibility of serious limitations in access to Medicare home health services.
本研究利用医疗保险家庭健康账单、医疗保险/医疗补助自动认证系统、医疗保险提供者分析与审查文件以及其他来源的数据，考察了1985年美国全国范围内医疗保险家庭健康服务使用情况在地区层面上的差异决定因素。采用加权两阶段最小二乘法回归，分析每1000名参保人中家庭健康服务使用者数量的差异以及每位使用者接受的平均就诊次数。数据汇总到大都市区和该州农村地区，得到343个分析单位。根据研究结果，在每参保人养老院床位较少、医院出院率较高、平均住院时间较短、熟练护理院健康就诊的医疗保险报销上限较高以及每参保人家庭健康机构较多的地区，使用家庭健康服务的医疗保险参保人比例较高。在其他条件相同的情况下，新英格兰地区的受益人使用家庭健康服务的可能性比气候相似的其他地区的受益人高40%。在每参保人机构较多且私立机构占比更高的地区，家庭健康服务使用者接受的平均就诊次数似乎更高。每位使用者接受的就诊次数在地区上似乎也存在很大差异。我们的结果表明，养老院床位获取受限导致医疗保险家庭健康服务使用水平较高，并且用家庭健康服务替代住院天数可能会进一步节省费用。研究表明，医疗保险报销上限可能会限制使用，而且在每参保人机构较少的地区，受益人获取服务可能会成为一个问题。这项研究还指出，即使控制了许多不同的解释变量，使用家庭健康服务的受益人比例在地区上仍存在显著差异。总体而言，我们的结果表明医疗保险家庭健康服务的获取可能存在严重限制。
