Swan J H, Benjamin A E
Health Care Administration Program, California State University, Long Beach 90840.
Health Serv Res. 1990 Aug;25(3):479-500.
Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. This model proposes that home health utilization is a function of nursing home bed capacity, of the utilization of nursing home beds by Medicaid patients, of other demand factors, and of supply factors. This model is supported by the data. Specifically, Medicare home health use in the 1978-1984 period was found to be negatively related to nursing home bed stock, positively related to Medicaid nursing home utilization, and related to several other supply and demand factors, as hypothesized by the model. The further model assumption that home health utilization does not affect the nursing home market could not be tested in this analysis, but will be addressed in future research by the authors.
家庭健康护理市场规模和成本的迅速增长、医疗保险的诊断相关分组（DRG）医院报销对出院后市场的未知影响，以及对解释家庭健康护理使用的州际差异因素普遍缺乏了解，所有这些都表明开发和测试医疗保险家庭健康护理使用模型的重要性。本文提出并测试了一个将州家庭健康护理使用作为疗养院市场函数的模型。该模型提出，家庭健康护理的使用是疗养院床位容量、医疗补助患者对疗养院床位的使用、其他需求因素以及供给因素的函数。该模型得到了数据的支持。具体而言，正如该模型所假设的，1978 - 1984年期间医疗保险家庭健康护理的使用与疗养院床位存量呈负相关，与医疗补助疗养院的使用呈正相关，并且与其他几个供给和需求因素相关。该模型进一步假设家庭健康护理的使用不会影响疗养院市场，这一假设在本分析中无法得到检验，但作者将在未来的研究中予以探讨。
