Home Care Reimbursement, Long-term Care Utilization, and Health Outcomes
AbstractLong-term care currently comprises almost 10% of national health expenditures and is projected to rise rapidly over coming decades. A key, and relatively poorly understood, element of long-term care is home health care. I use a substantial change in Medicare reimbursement policy, which took the form of tightly binding average per-patient reimbursement caps, to address several questions about the market for home care. I find that the reimbursement change was associated with a large drop in the provision of home care. This drop was concentrated among unhealthy beneficiaries, which is consistent with the incentives for patient selection inherent in the per-patient caps. I find that the decline in home health utilization was not offset by increases in institutional long-term care or other medical care and that there were no associated adverse health consequences. However, approximately one-quarter of the decline in Medicare spending was offset by increases in out-of-pocket expenditures for home health care, with the offset concentrated in higher income populations. Despite the value of home health care implied by the out-of-pocket expenditures, I find that the welfare implications of the reimbursement change were ambiguous.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoPaper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 10414.
Date of creation: Apr 2004
Date of revision:
Note: AG HC
Contact details of provider:
Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.
Web page: http://www.nber.org
More information through EDIRC
Other versions of this item:
- McKnight, Robin, 2006. "Home care reimbursement, long-term care utilization, and health outcomes," Journal of Public Economics, Elsevier, vol. 90(1-2), pages 293-323, January.
- Robin McKnight, 2004. "Home Care Reimbursement, Long-term Care Utilization,And Health Outcomes," University of Oregon Economics Department Working Papers 2004-6, University of Oregon Economics Department.
- I1 - Health, Education, and Welfare - - Health
This paper has been announced in the following NEP Reports:
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Grabowski, David C., 2001. "Medicaid reimbursement and the quality of nursing home care," Journal of Health Economics, Elsevier, vol. 20(4), pages 549-569, July.
- Norton, Edward C., 2000. "Long-term care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 17, pages 955-994 Elsevier.
- Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
- Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004.
"How Much Should We Trust Differences-in-Differences Estimates?,"
The Quarterly Journal of Economics,
MIT Press, vol. 119(1), pages 249-275, February.
- Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2002. "How Much Should We Trust Differences-in-Differences Estimates?," NBER Working Papers 8841, National Bureau of Economic Research, Inc.
- Skinner, Jonathan & Fisher, Elliott, 1997. "Regional Disparities in Medicare Expenditures: An Opportunity for Reform," National Tax Journal, National Tax Association, vol. 50(3), pages 413-25, September.
- Chalkley, Martin & Malcomson, James M., 2000.
"Government purchasing of health services,"
Handbook of Health Economics,
in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 15, pages 847-890
- Chalkley, M. & Malcomson, J.M., 1998. "Government purchasing of health services," Discussion Paper Series In Economics And Econometrics 9821, Economics Division, School of Social Sciences, University of Southampton.
- Orsini, Chiara, 2010. "Changing the way the elderly live: Evidence from the home health care market in the United States," Journal of Public Economics, Elsevier, vol. 94(1-2), pages 142-152, February.
- Katherine Baicker & Amitabh Chandra, 2011. "Aspirin, angioplasty and proton beam therapy: the economics of smarter health-care spending," Proceedings - Economic Policy Symposium - Jackson Hole, Federal Reserve Bank of Kansas City, pages 197-235.
- Sood, Neeraj & Huckfeldt, Peter J. & Grabowski, David C. & Newhouse, Joseph P. & Escarce, José J., 2013.
"The effect of prospective payment on admission and treatment policy: Evidence from inpatient rehabilitation facilities,"
Journal of Health Economics,
Elsevier, vol. 32(5), pages 965-979.
- Neeraj Sood & Peter J. Huckfeldt & David C. Grabowski & Joseph P. Newhouse & José J. Escarce, 2011. "The Effect of Prospective Payment on Admission and Treatment Policy: Evidence from Inpatient Rehabilitation Facilities," NBER Working Papers 17125, National Bureau of Economic Research, Inc.
- Gary V. Engelhardt & Nadia Greenhalgh-Stanley, 2008. "Public Long-Term Care Insurance and the Housing and Living Arrangements of the Elderly: Evidence from Medicare Home Health Benefits," Working Papers, Center for Retirement Research at Boston College wp2008-15, Center for Retirement Research, revised Dec 2008.
- Huckfeldt, Peter J. & Sood, Neeraj & Escarce, Jose J. & Grabowski, David C. & Newhouse, Joseph P., 2012.
"Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems,"
Working Paper Series
rwp12-007, Harvard University, John F. Kennedy School of Government.
- Peter J. Huckfeldt & Neeraj Sood & José J Escarce & David C. Grabowski & Joseph P. Newhouse, 2012. "Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems," NBER Working Papers 17870, National Bureau of Economic Research, Inc.
- Engelhardt, Gary V. & Greenhalgh-Stanley, Nadia, 2010. "Home health care and the housing and living arrangements of the elderly," Journal of Urban Economics, Elsevier, vol. 67(2), pages 226-238, March.
- Jonathan Skinner, 2010. "Comment on "The Narrowing Dispersion of Medicare Expenditures 1997-2005"," NBER Chapters, in: Research Findings in the Economics of Aging, pages 407-411 National Bureau of Economic Research, Inc.
- Bernard van den Berg & Wolter Hassink, 2006. "Moral hazard and cash benefits in long-term home care, CHERE Working Paper 2006/12," Working Papers 2006/12, CHERE, University of Technology, Sydney.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: ().
If references are entirely missing, you can add them using this form.