Hellinger F J
Health Serv Res. 1977 Spring;12(1):11-8.
The question of whether Medicare coverage of outpatient services, nursing home care, and home health care reduced the use of short-term hospitals by Medicare beneficiaries, and whether reduced hospital use saved the Medicare program money, is reexamined by use of a simultaneous-equations model estimated by the two-stage least-squares method. It is argued that all alternative modes of care must be examined simultaneously for accurate results. The findings partly support and partly contradict results of previous studies: both outpatient care and nursing home care can substitute for hospital care, but a complementary relationship between outpatient and nursing home care indicates that the additional coverage resulted in greater, not less, expenditure by Medicare.
医疗保险对门诊服务、疗养院护理和家庭保健的覆盖是否减少了医疗保险受益人的短期医院使用，以及减少医院使用是否为医疗保险计划节省了资金，这一问题通过使用两阶段最小二乘法估计的联立方程模型进行了重新审视。有人认为，必须同时检查所有替代护理模式才能得到准确结果。研究结果部分支持且部分与先前研究的结果相矛盾：门诊护理和疗养院护理都可以替代医院护理，但门诊护理和疗养院护理之间的互补关系表明，额外的覆盖导致医疗保险支出增加，而非减少。
