Abstract
Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The home health interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.
Keywords:
Medicare; Prospective payment; Selection; Treatment intensity.
Copyright © 2014 Elsevier B.V. All rights reserved.
Publication types
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Research Support, N.I.H., Extramural
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Research Support, U.S. Gov't, P.H.S.
MeSH terms
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Aged
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Aged, 80 and over
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Arthroplasty, Replacement / economics
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Health Care Costs / statistics & numerical data
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Health Care Reform / economics
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Health Care Reform / organization & administration*
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Hip Fractures / economics
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Hip Fractures / therapy
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Home Care Agencies / economics
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Home Care Agencies / organization & administration*
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Hospitalization / economics
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Hospitalization / statistics & numerical data
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Humans
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Medicare / economics
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Medicare / organization & administration*
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Models, Economic
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Outcome and Process Assessment, Health Care
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Prospective Payment System / economics
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Prospective Payment System / organization & administration*
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Reimbursement Mechanisms / economics
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Reimbursement Mechanisms / organization & administration
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Stroke / economics
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Stroke / therapy
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United States