Racial/Ethnic Disparities in Access to Medicare Home Health Care: The Disparate Impact of Policy

Abstract

The Balanced Budget Act of 1997 dramatically decreased reimbursements for traditional Medicare home health patients. A multivariate analysis of Medicare Current Beneficiary Survey data showed that African American and "other" users experienced greater decreases in home care between 1996 and 1998 than did White users. These results suggest (a) race/ethnicity is an independent factor in determining service use post-BBA and (b) health policy has a disparate impact on minority older adults. Capitated payment systems must be pursued cautiously to avoid negative effects on vulnerable populations. The potential for current and future Medicare policy changes to negatively affect vulnerable populations is also discussed.

Medicare Home Health Payment Reform May Jeopardize Access For Clinically Complex And Socially Vulnerable Patients

“…Previous work suggests that changes in Medicare reimbursement policy influence service delivery patterns in the home health care setting, including reductions in services provided to frailer patients with greater health impairments. [13][14][15][16] Changes in reimbursement policy that were intended to reduce spending have led to large cutbacks in service delivery for patients who have greater cognitive, health, and functional impairments.…”

“…11,12 Research has shown that policies decreasing Medicare's payments to home health care providers are linked to greater reductions in services for beneficiaries with greater functional, health, and cognitive impairments than in those for healthier beneficiaries with fewer functional and cognitive impairments. [13][14][15][16] These studies highlight the need to examine whether inefficiencies are present within the current Medicare reimbursement model that provide financial disincentives for serving the most vulnerable and clinically complex of the beneficiaries who receive home health care.…”

“…30,31 Researchers have called for further studies to investigate whether the current Medicare prospective payment system underestimates the needs and costs of these vulnerable patients. 14 Conceptual Framework The conceptual model that guided our study is graphically displayed in the online Appendix. 32 This model was informed by previous work that examined the role of social and health system factors in health service use among older adults.…”

Racial/Ethnic Disparities in Home Health Care: Charting a Course for Future Research

“…Comparisons of pre-and post-BBA Medicare data found significantly greater decreases in: number of users per 1,000 enrollees, intensity of service, level of agency reimbursement, number of non-skilled service visits, and length of service for non-White beneficiaries (Davitt & Kaye, 2010;McCall et al, 2001McCall et al, , 2003Murkofsky, Phillips, McCarthy, Davis, & Hamel, 2003). Davitt and Kaye (2010), based on a comprehensive set of control variables, suggest that race may be an independent and separate factor in the determination of service delivery post-BBA. Other studies found no differences by race/ethnicity in likelihood of home health use, number of visits, or length of service (Fitzgerald et al, 2006;Han, Remsburg, Lubitz, & Goulding, 2004;Liu, Long, & Dowling, 2003).…”

“…Other studies found no differences by race/ethnicity in likelihood of home health use, number of visits, or length of service (Fitzgerald et al, 2006;Han, Remsburg, Lubitz, & Goulding, 2004;Liu, Long, & Dowling, 2003). Limitations in these studies included: lack of controls for key predisposing and enabling factors (McCall et al, 2001); lack of controls for health or functional status (McCall et al, 2003); and no measure of SES (Liu et al, 2003;Murkofsky et al, 2003), only income and education (Davitt & Kaye, 2010). Likewise, analyses were conducted on limited racial/ethnic subgroups.…”