Home Care NetWork
Home Care Literature Reviews 2004
Economics:
Fortinsky RH, Fenster JR, Judge JO. Medicare and Medicaid home health and Medicaid waiver services for dually eligible older adults: risk factors for use and correlates of expenditures. Gerontologist. 2004;44:739-49.
This large database analysis determined factors he associated with the use of home health services by 5,232 dually eligible individuals enrolled in Connecticut's Medicaid home- and community-based services waiver program for the aged. Multivariate models controlling for medical conditions and sociodemographic variables found similar functional disability levels were strongly associated with the probability of the use of and expenditures for Medicare home health and Medicaid home health services. Severe cognitive impairment was strongly associated with greater Medicaid waiver service expenditures. This study found great similarity between Medicare and Medicaid home health service recipients in terms of both use and expenditures.
Han B, Remsburg RE, Lubitz J, Goulding M. Payment source and length of use among home health agency discharges. Med Care. 2004;42:1081-90.
This large database analysis of 18,416 recipients of home and hospice care found that, after adjusting for covariates, Medicare HHC patients were from 0.52 to 0.75 times less likely to be discharged within 30 days in 1991-1996 than in 1997-1998. Medicaid patients were 0.37 times less likely to be discharged within 30 days in 1991-1992 than in 1997-1998. Patients with private insurance were 2.05 times more likely to be discharged within 30 days in 1993-1994 than in 1997-1998. No significant difference in length of use was found at the multivariate level between 1997-1998 and 1999-2000 among HHC patients with Medicare, Medicaid, or private health insurance. Results for being discharged within 60 days were similar to these described above. This study is a sober reminder of the impact of reimbursement on provision of services.
Chappell NL, Dlitt BH, Hollander MJ, Miller JA, McWilliam C. Comparative costs of home care and residential care. Gerontologist. 2004;44:389-400.
This Canadian survey comparing the costs of home care for seniors as a substitute for long-term institutional services in two Canadian cities found that costs were significantly lower for community clients than for facility clients, regardless of whether costs only to the government were taken into account or whether both formal and informal costs were taken into account. I suspect that caregivers' time was still undervalued and I'm not sure the groups were truly comparable but the outcomes are still interesting and probably relevant to the U.S.
Home Care Literature Reviews 2003
Economics:
Anderson WL, Kenney GS, Rabiner DJ. Adoption of retrospective Medicare maximization billing practices by state Medicaid home care programs. J Health Polit Policy Law. 2003;28:859-81.
This large data base analysis of Medicare maximization billing practices whereby some state Medicaid programs transferred costs for home care claims to the Medicare program to reduce their liability and increase beneficiary access to Medicare coverage for home care services found that seven states recovered as much as $265 million from Medicare in state and federal dollars during the 1990s. Ratios of recovered expenditures-to-costs incurred for retrospective billing practices ranged from 5:1 to 7:1. An interesting picture of gamesmanship between state and federal governments.
Corazzini K. How state-funded home care programs respond to changes in Medicare home health care: resource allocation decisions on the front line. Health Serv Res. 2003;38:1263-81.
This cross-sectional survey of 355 case managers and 26 agency directors responsible for administering the Massachusetts Home Care Program for low-income elders examined how case managers in that state-funded home care program allocated home care services in response to information about a client's Medicare home health care status when Medicare funding became more restrictive with particular attention to the influence of work environment,. Regardless of case mix or work environment, case managers did not supplement extant Medicare home health services but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. While it apparently did not impact on supplementation of home health services, work environment did affect overall care plan levels supporting the possibility that nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics. By in large, it appears that case managers tried to be fair (or generous depending on your perspective) when confronted by changes in policy.
Shea D, Davey A, Femia EE, Zarit SH, Sundstrom G, Berg S, Smyer MA. Exploring assistance in Sweden and the United States. Gerontologist. 2003;43:712-21
This large data base analysis compared the need for and receipt of assistance with activities of daily living (ADLs) in the United States and Sweden where a universal system pays for all community-based services. While the overall level of ADL assistance was similar, there was greater use of paid formal services in Sweden and more unpaid informal use in the United States. Assistance with ADLs seemed to be more targeted in Sweden. These results do not seem surprising.
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