Reschovsky J D
Center for Studying Health Systems Change, Washington, DC 20024-2512, USA.
Med Care. 1998 Apr;36(4):475-90. doi: 10.1097/00005650-199804000-00004.
Nursing homes provide care for persons with both post-acute and chronic conditions. In general, these two types of patients are associated with short and long stays, respectively. They also tend to be covered by different public or private insurance plans. The author investigated whether and how the demand for these two types of nursing home care differ. How alternative definitions of post-acute and chronic care nursing home stays affect estimates also was explored.
Data on a sample of elderly persons from the National Long-Term Care Channeling Demonstration was used. To account for market disequilibrium, demand was estimated using a bivariate probit with partial observability model.
Differences were found in the demand for the two types of nursing home care. For instance, economic factors and functional and cognitive limitations were relatively more important in the demand for nursing home care for chronic conditions. Further, chronic care patients appeared more likely to face problems of access into nursing homes. Classifying nursing home stays by payer, rather than by length of stay, captured expectations at admission and appeared to reflect consumer behavior better.
Differentiating post-acute and chronic care nursing home stays provides more meaningful information on consumer demand for nursing home care and will facilitate policy analysis in this area.
疗养院为急性后期和慢性病患者提供护理服务。一般来说，这两类患者分别与短期和长期住院相关。他们往往也由不同的公共或私人保险计划承保。作者调查了这两类疗养院护理需求是否存在差异以及如何存在差异。还探讨了急性后期和慢性护理疗养院住院的替代定义如何影响估计结果。
使用了来自国家长期护理分流示范项目的老年人样本数据。为了考虑市场失衡，使用具有部分可观测性模型的双变量概率单位模型来估计需求。
发现这两类疗养院护理需求存在差异。例如，经济因素以及功能和认知限制在慢性病疗养院护理需求中相对更为重要。此外，慢性护理患者似乎更有可能面临进入疗养院的问题。按付款人而非住院时间对疗养院住院进行分类，抓住了入院时的预期，似乎能更好地反映消费者行为。
区分急性后期和慢性护理疗养院住院能提供关于消费者对疗养院护理需求的更有意义信息，并将促进该领域的政策分析。
