Department of Economics, University of the Pacific, 3601 Pacific Ave., Stockton, CA 95211, USA.
Health Care Manag Sci. 2010 Dec;13(4):319-33. doi: 10.1007/s10729-010-9132-9. Epub 2010 Jul 6.
In 1981 Congress introduced Home and Community Based Services (HCBS) waivers in an attempt to contain Medicaid long-term care expenditures. This paper analyzes the efficacy of the waiver program. To date, little is known about its impact on cost containment. Using state-level Medicaid data on expenditures and the number of individuals participating in HCBS waivers between 1992 and 2000, this study estimates the impact of HCBS waivers on total Medicaid expenditures as well as on Medicaid institutional, home health and pharmaceutical expenditures. A fixed effects model is used to analyze Medicaid expenditures using variation in the size of HCBS waiver programs across states and over time. The results, robust across multiple specifications, show increases rather than decreases in total Medicaid spending as well as increases in the other Medicaid spending categories analyzed. This implies that there is no evidence of substitution from institutional care to the HCBS waiver program or that cost-shifting is occurring. In fact, the large magnitude of the estimated spending increases suggests the waivers may induce more people to enter the Medicaid program.
1981 年，国会引入了“家庭和社区为基础的服务”（HCBS）豁免，试图控制医疗补助长期护理支出。本文分析了豁免计划的效果。迄今为止，人们对其在控制成本方面的影响知之甚少。本研究利用 1992 年至 2000 年间州级医疗补助支出和参与 HCBS 豁免的人数数据，估计了 HCBS 豁免对医疗补助总支出以及医疗补助机构、家庭保健和药品支出的影响。使用固定效应模型，根据各州 HCBS 豁免计划的规模和时间变化，分析医疗补助支出。结果在多种规格下都是稳健的，表明总医疗补助支出增加，而不是减少，以及分析的其他医疗补助支出类别也增加。这意味着没有证据表明从机构护理向 HCBS 豁免计划的替代，也没有发生成本转移。事实上，估计的支出增加幅度很大，这表明豁免可能会促使更多的人加入医疗补助计划。
