Mroz Tracy M, Patterson Davis G, Frogner Bianca K
Tracy M. Mroz (
Davis G. Patterson is a research assistant professor in the Department of Family Medicine, University of Washington.
Health Aff (Millwood). 2020 Jun;39(6):949-957. doi: 10.1377/hlthaff.2019.00952.
Intermittently since 2001, Medicare has provided a percentage increase over standard payments to home health agencies that serve rural beneficiaries. Yet the effect of rural add-on payments on the supply of home health agencies that serve rural communities is unknown. Taking advantage of the pseudo-natural experiment created by varying rural add-on payment amounts over time, we used data from Home Health Compare to examine how the payments affected the number of home health agencies serving rural counties. Our results suggest that while supply changes are similar in rural counties adjacent to urban areas and in urban counties regardless of add-on payments, only higher add-on payments (of 5 percent or 10 percent) keep supply changes in rural counties not adjacent to urban areas on pace with those in urban counties. Our findings support the recent shift from broadly applied to targeted rural add-on payments but raise questions about the effects of the amount and eventual sunset of these payments on the supply of home health agencies serving remote rural communities.
自2001年以来，医疗保险机构（Medicare）不定期地为服务农村受益人的家庭健康机构提供高于标准支付额的一定比例增长。然而，农村附加支付对服务农村社区的家庭健康机构供应的影响尚不清楚。利用随时间变化的农村附加支付金额所产生的准自然实验，我们使用了“家庭健康比较”（Home Health Compare）的数据来研究这些支付如何影响服务农村县的家庭健康机构数量。我们的结果表明，虽然无论附加支付情况如何，城市周边农村县和城市县的供应变化相似，但只有较高的附加支付（5%或10%）才能使非城市周边农村县的供应变化与城市县的供应变化保持同步。我们的研究结果支持了最近从广泛应用的农村附加支付向有针对性的农村附加支付的转变，但也引发了关于这些支付的金额及其最终终止对服务偏远农村社区的家庭健康机构供应的影响的问题。
