Dubay L
Urban Institute, Washington, District of Columbia 20037.
Med Care. 1993 Feb;31(2):111-29. doi: 10.1097/00005650-199302000-00003.
Recent closings of rural hospitals, anecdotal evidence of rural elderly persons having difficulty gaining access to health services, and the large and growing number of elderly persons living in rural areas has renewed concern about access to care for the rural elderly. In this study, 1987 Medicare skilled nursing Facility (SNF) bills were used to examine differences in urban and rural use of the SNF benefit. Using multivariate techniques, the analysis found that Medicare enrollees living in rural and large metropolitan areas used the SNF benefit at a rate 20% and 17% higher than enrollees living in small and medium-sized metropolitan areas, respectively. However, in rural areas the swing-bed program plays a major role in assuring access to the SNF benefit. Without the swing-bed program, rural enrollees would use the SNF benefit at a rate comparable to that of enrollees in small and medium-sized metropolitan areas. The importance of the swing-bed program cannot be underscored, because relative to urban enrollees, rural enrollees disproportionately live in nursing home markets that are not amenable to serving Medicare patients.
近期农村医院的关闭、农村老年人难以获得医疗服务的 anecdotal evidence，以及农村地区老年人口数量众多且不断增加，这再次引发了人们对农村老年人医疗服务可及性的担忧。在本研究中，1987年医疗保险熟练护理设施（SNF）账单被用于检验城市和农村地区对SNF福利的使用差异。通过多变量技术分析发现，居住在农村和大城市地区的医疗保险参保者使用SNF福利的比例分别比居住在中小城市地区的参保者高出20%和17%。然而，在农村地区，摇摆病床项目在确保获得SNF福利方面发挥着重要作用。如果没有摇摆病床项目，农村参保者使用SNF福利的比例将与中小城市地区的参保者相当。摇摆病床项目的重要性怎么强调都不为过，因为相对于城市参保者，农村参保者不成比例地居住在不适合为医疗保险患者服务的养老院市场。
