Weech-Maldonado Robert, Qaseem Amir, Mkanta William
Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL 32610-0195, USA.
Health Serv Manage Res. 2009 Feb;22(1):1-7. doi: 10.1258/hsmr.2008.008002.
We examined the impact of environmental factors on USA nursing homes' participation in the subacute care market. Findings suggest that the Balanced Budget Act of 1997 did not have a significant impact in the participation of nursing homes in the subacute care market from 1998 to 2000. However, there was a declining trend in the participation of nursing homes in the subacute care market after the implementation of Medicare prospective payment system (PPS). Furthermore, nursing homes with a higher proportion of Medicare residents were more likely to exit the subacute care market after PPS. Results also suggest that nursing homes have responded strategically to the environmental demand for subacute care services. Nursing homes located in markets with higher Medicare managed care penetration were more likely to offer subacute care services. Environmental munificence was also an important predictor of nursing home innovation into subacute care. Nursing homes in states with higher Medicaid reimbursement and those in less competitive markets were more likely to participate in the subacute care market.
我们研究了环境因素对美国疗养院参与亚急性护理市场的影响。研究结果表明，1997年的《平衡预算法案》对1998年至2000年疗养院参与亚急性护理市场没有显著影响。然而，医疗保险预期支付系统（PPS）实施后，疗养院参与亚急性护理市场的趋势呈下降趋势。此外，医疗保险居民比例较高的疗养院在PPS实施后更有可能退出亚急性护理市场。结果还表明，疗养院已对亚急性护理服务的环境需求做出了战略回应。位于医疗保险管理式护理渗透率较高市场的疗养院更有可能提供亚急性护理服务。环境宽松也是疗养院创新进入亚急性护理领域的重要预测因素。医疗补助报销较高州的疗养院以及竞争较小市场的疗养院更有可能参与亚急性护理市场。
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