Mukamel Dana B, Fortinsky Richard H, White Alan, Harrington Charlene, White Laura M, Ngo-Metzger Quyen
University of California Irvine-Health Policy Research Institute.
University of Connecticut Center on Aging.
Medicare Medicaid Res Rev. 2014 Feb 12;4(1). doi: 10.5600/mmrr2014-004-01-a03. eCollection 2014.
To examine the cost structure of home health agencies by estimating an empirical cost function for those that are Medicare-certified, ten years following the implementation of prospective payment.
2010 national Medicare cost report data for certified home health agencies were merged with case-mix information from the Outcome and Assessment Information Set (OASIS). We estimated a fully interacted (by tax status) hybrid cost function for 7,064 agencies and calculated marginal costs as percent of total costs for all variables.
The home health industry is dominated by for-profit agencies, which tend to be newer than the non-profit agencies and to have higher average costs per patient but lower costs per visit. For-profit agencies tend to have smaller scale operations and different cost structures, and are less likely to be affiliated with chains. Our estimates suggest diseconomies of scale, zero marginal cost for contracting with therapy workers, and a positive marginal cost for contracting with nurses, when controlling for quality.
Our findings suggest that efficiencies may be achieved by promoting non-profit, smaller agencies, with fewer contract nursing staff. This conclusion should be tested further in future studies that address some of the limitations of our study.
通过估算实施前瞻性支付十年后获得医疗保险认证的家庭健康机构的经验成本函数，来研究这些机构的成本结构。
将2010年获得认证的家庭健康机构的全国医疗保险成本报告数据与来自结果与评估信息集（OASIS）的病例组合信息合并。我们为7064家机构估算了一个完全交互（按税收状况）的混合成本函数，并计算了所有变量的边际成本占总成本的百分比。
家庭健康行业以营利性机构为主，这些机构往往比非营利性机构更新，每位患者的平均成本较高，但每次就诊成本较低。营利性机构往往运营规模较小，成本结构不同，且不太可能隶属于连锁机构。我们的估计表明，在控制质量的情况下，存在规模不经济，与治疗工作人员签约的边际成本为零，与护士签约的边际成本为正。
我们的研究结果表明，通过推广非营利性、规模较小且合同护士较少的机构，可能会提高效率。这一结论应在未来研究中进一步检验，这些研究要解决我们研究的一些局限性。
