Benjamin A E
Med Care. 1986 Jun;24(6):535-47. doi: 10.1097/00005650-198606000-00008.
Of the key federal programs that finance in-home services to the elderly, the Medicare program represents the largest and fastest growing. Although Medicare is a federal program, utilization and expenditures for home care vary widely across the states. Building on the work of Feldstein, Scanlon, and others, theory and data are presented that attempt to illuminate reasons why such variations exist. Using program data by state for 1982, nearly three fourths of the variation in home health utilization (R2 = 0.72) is explained by seven state characteristics. About three fifths of the variation in expenditures (R2 = 0.61) is accounted for by six state factors. Of most explanatory importance are home health agency (HHA) supply, need levels, presence of alternative sources of care, sources of referrals, and state resources. The results suggest the need to give more analytic attention to the impact of the market share of proprietary HHAs in explaining expenditure variations and the effects of total supply on utilization and spending.
在为老年人提供居家服务的主要联邦项目中，医疗保险项目规模最大且增长最快。尽管医疗保险是一个联邦项目，但各州的居家护理利用率和支出差异很大。基于费尔德斯坦、斯坎伦等人的研究成果，本文提出了理论和数据，试图阐明存在这些差异的原因。利用1982年各州的项目数据，居家健康护理利用率近四分之三的差异（R² = 0.72）可由七个州的特征来解释。支出差异约五分之三（R² = 0.61）可由六个州的因素来解释。最具解释力的因素包括居家健康护理机构（HHA）的供应、需求水平、替代护理来源的存在、转诊来源以及州资源。结果表明，在解释支出差异时，需要更多地从分析角度关注营利性居家健康护理机构的市场份额的影响，以及总供应对利用率和支出的影响。
