Kane R L, Kane R A, Ladd R C, Veazie W N
University of Minnesota, USA.
J Health Polit Policy Law. 1998 Apr;23(2):363-90. doi: 10.1215/03616878-23-2-363.
Pressures to turn over responsibility for long-term care to the states will exacerbate the already sizable difference in such efforts. This article describes the nature of the interstate variation in the types and amounts of long-term care provided under Medicaid. The average Medicaid long-term care expenditure on persons sixty-five years and older varies from $2,720 in New York to $380 in Arizona. Likewise, payments for home and community-based services (HCBS) vary from $1,180 in New York to $29 in Mississippi. Only a modest portion (28 percent) of the variance in total long-term care expenditures appears to be related to differences in population characteristics, and even less (7 percent) appears to be related to differences in HCBS expenditures. When supply factors (e.g., nursing home beds) are added, the explained variance increases to 52 percent and 17 percent, respectively. Medicare replaces some--but not most--of the difference in Medicaid home and community-based services payments.
将长期护理责任移交给各州的压力将加剧此类努力中已然相当大的差异。本文描述了在医疗补助计划下提供的长期护理类型和数量方面州际差异的性质。医疗补助计划为65岁及以上人群的长期护理平均支出从纽约的2720美元到亚利桑那州的380美元不等。同样，家庭和社区服务（HCBS）的支付从纽约的1180美元到密西西比州的29美元不等。长期护理总支出中只有一小部分（28%）的差异似乎与人口特征差异有关，与家庭和社区服务支出差异相关的则更少（7%）。当加入供应因素（如疗养院床位）时，可解释的差异分别增加到52%和17%。医疗保险弥补了医疗补助计划在家庭和社区服务支付方面的一些差异，但不是大部分。
