Nyman J A, Svetlik M A
Division of Health Services Research and Policy, University of Minnesota, Minneapolis.
Public Health Rep. 1989 Jul-Aug;104(4):335-41.
The relationship between the average cost of home health care and the case mix of patients served by the home health agency is investigated using 1983 data from Wisconsin's home health care agencies. In contrast to previous work, case mix is shown to have a significant effect on the home health agency's average costs. The methods used in the previous work are evaluated, and differences between the earlier study and the present study are discussed to explain the divergent results. Also, average costs are shown to decrease with output, to increase with the proportion of private patients served by the agency, and to be higher if the home health agency is located in an urban area or if it has a proprietary charter. The implications of this research for the design of an appropriate home health reimbursement policy are discussed. Primarily, it is argued that, although future research might confirm the relationship between average costs and case mix for home health agencies, we cannot necessarily conclude that reimbursement rates must be adjusted to account for differences in case mix as many States are now doing for nursing home reimbursement. Policies must take into account the fundamental differences between home health agencies and nursing homes, and their respective markets, in order to be effective.
利用威斯康星州家庭保健机构1983年的数据，对家庭保健的平均成本与家庭保健机构所服务患者的病例组合之间的关系进行了调查。与之前的研究不同，病例组合对家庭保健机构的平均成本有显著影响。对之前研究中使用的方法进行了评估，并讨论了早期研究与本研究之间的差异，以解释结果的分歧。此外，研究表明平均成本随产出下降，随机构服务的私人患者比例上升，并且如果家庭保健机构位于城市地区或拥有特许经营执照，成本会更高。讨论了这项研究对设计适当的家庭保健报销政策的影响。主要观点是，虽然未来的研究可能会证实家庭保健机构平均成本与病例组合之间的关系，但我们不一定能得出必须像许多州现在对疗养院报销那样调整报销率以考虑病例组合差异的结论。政策必须考虑到家庭保健机构与疗养院及其各自市场之间的根本差异，才能有效。
