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. 1990 Aug;25(3):479–500.

Medicare home health utilization as a function of nursing home market factors.

J H Swan 1, A E Benjamin 1
PMCID: PMC1065640  PMID: 2199414

Abstract

Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. This model proposes that home health utilization is a function of nursing home bed capacity, of the utilization of nursing home beds by Medicaid patients, of other demand factors, and of supply factors. This model is supported by the data. Specifically, Medicare home health use in the 1978-1984 period was found to be negatively related to nursing home bed stock, positively related to Medicaid nursing home utilization, and related to several other supply and demand factors, as hypothesized by the model. The further model assumption that home health utilization does not affect the nursing home market could not be tested in this analysis, but will be addressed in future research by the authors.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benjamin A. E. Determinants of state variations in home health utilization and expenditures under Medicare. Med Care. 1986 Jun;24(6):535–547. doi: 10.1097/00005650-198606000-00008. [DOI] [PubMed] [Google Scholar]
  2. Bishop C. E., Stassen M. Prospective reimbursement for home health care: context for an evolving policy. Pride Inst J Long Term Home Health Care. 1986 Winter;5(1):17–26. [PubMed] [Google Scholar]
  3. Doty P. Family care of the elderly: the role of public policy. Milbank Q. 1986;64(1):34–75. [PubMed] [Google Scholar]
  4. Evashwick C. Home health care: current trends and future opportunities. J Ambul Care Manage. 1985 Nov;8(4):4–17. doi: 10.1097/00004479-198511010-00003. [DOI] [PubMed] [Google Scholar]
  5. Feder J., Scanlon W. Regulating the bed supply in nursing homes. Milbank Mem Fund Q Health Soc. 1980 Winter;58(1):54–88. [PubMed] [Google Scholar]
  6. Harrington C., Swan J. H., Grant L. A. Nursing home bed capacity in the States, 1978-86. Health Care Financ Rev. 1988 Summer;9(4):81–97. [PMC free article] [PubMed] [Google Scholar]
  7. Harrington C., Swan J. H. The impact of state Medicaid nursing home policies on utilization and expenditures. Inquiry. 1987 Summer;24(2):157–172. [PubMed] [Google Scholar]
  8. Hedrick S. C., Inui T. S. The effectiveness and cost of home care: an information synthesis. Health Serv Res. 1986 Feb;20(6 Pt 2):851–880. [PMC free article] [PubMed] [Google Scholar]
  9. Hughes S. L. Apples and oranges? A review of evaluations of community-based long-term care. Health Serv Res. 1985 Oct;20(4):461–488. [PMC free article] [PubMed] [Google Scholar]
  10. Kramer A. M., Shaughnessy P. W., Pettigrew M. L. Cost-effectiveness implications based on a comparison of nursing home and home health case mix. Health Serv Res. 1985 Oct;20(4):387–405. [PMC free article] [PubMed] [Google Scholar]
  11. Levit K. R., Lazenby H., Waldo D. R., Davidoff L. M. National health expenditures, 1984. Health Care Financ Rev. 1985 Fall;7(1):1–35. [PMC free article] [PubMed] [Google Scholar]
  12. Manton K. G., Soldo B. J. Dynamics of health changes in the oldest old: new perspectives and evidence. Milbank Mem Fund Q Health Soc. 1985 Spring;63(2):206–285. [PubMed] [Google Scholar]
  13. Pillemer K. A., Levine A. S. The Omnibus Reconciliation Act of 1980 and its effects on home health care. Home Health Care Serv Q. 1981 Summer;2(2):5–39. doi: 10.1300/j027v02n02_02. [DOI] [PubMed] [Google Scholar]
  14. Sager M. A., Leventhal E. A., Easterling D. V. The impact of Medicare's prospective payment system on Wisconsin nursing homes. JAMA. 1987 Apr 3;257(13):1762–1766. [PubMed] [Google Scholar]
  15. Scanlon W. J. A theory of the nursing home market. Inquiry. 1980 Spring;17(1):25–41. [PubMed] [Google Scholar]
  16. Shaughnessy P. W., Schlenker R. E., Polesovsky M. B. Medicaid and non-Medicaid case mix differences in Colorado nursing homes. Med Care. 1986 Jun;24(6):482–495. doi: 10.1097/00005650-198606000-00003. [DOI] [PubMed] [Google Scholar]
  17. Sherwood S., Morris J. N., Ruchlin H. S. Alternative paths to long-term care: nursing home, geriatric day hospital, senior center, and domiciliary care options. Am J Public Health. 1986 Jan;76(1):38–44. doi: 10.2105/ajph.76.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Smits H. L., Feder J., Scanlon W. Medicare's nursing-home benefit: variations in interpretation. N Engl J Med. 1982 Sep 30;307(14):855–862. doi: 10.1056/NEJM198209303071404. [DOI] [PubMed] [Google Scholar]
  19. Stone R., Cafferata G. L., Sangl J. Caregivers of the frail elderly: a national profile. Gerontologist. 1987 Oct;27(5):616–626. doi: 10.1093/geront/27.5.616. [DOI] [PubMed] [Google Scholar]
  20. Swan J. H., Harrington C. Estimating undersupply of nursing home beds in states. Health Serv Res. 1986 Apr;21(1):57–83. [PMC free article] [PubMed] [Google Scholar]
  21. Swan J. H., Harrington C., Grant L. A. State Medicaid reimbursement for nursing homes, 1978-86. Health Care Financ Rev. 1988 Spring;9(3):33–50. [PMC free article] [PubMed] [Google Scholar]
  22. Swan J. H. The substitution of nursing home for inpatient psychiatric care. Community Ment Health J. 1987 Spring;23(1):3–18. doi: 10.1007/BF00752820. [DOI] [PubMed] [Google Scholar]
  23. Van Gelder S., Bernstein J. Home health care in the era of hospital prospective payment: some early evidence and thoughts about the future. Pride Inst J Long Term Home Health Care. 1986 Winter;5(1):3–11. [PubMed] [Google Scholar]
  24. Wood J. B. The effects of cost-containment on home health agencies. Home Health Care Serv Q. 1985;6(4):59–78. doi: 10.1300/j027v06n04_06. [DOI] [PubMed] [Google Scholar]

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