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Previous Volume 335:324-329 August 1, 1996 Number 5 Next

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ABSTRACT

Background Medicare's home health care program, consisting primarily of home visits by nurses and health aides, was conceived as a means to facilitate hospital discharge. Because home health care is now one of the fastest-growing categories of Medicare expenditures, we analyzed Medicare claims data to determine current patterns of use.

Methods We used 1993 data from Medicare's National Claims History File to examine the temporal relation between home visits and hospital discharge, as well as the number of months Medicare enrollees received home health care. To determine whether home visits replaced hospital services, we calculated population-based utilization rates, adjusted for age and sex, for enrollees living in the 310 U.S. metropolitan statistical areas and determined whether the areas with higher rates of home health care also had lower admission rates or shorter lengths of stay. Finally, we compared the geographic variation in use of home health care with that of other Medicare services.

Results Roughly 3 million Medicare enrollees received over 160 million home health care visits in 1993. Seventy-eight percent of the visits either occurred more than a month after hospital discharge (35 percent) or were not associated with any inpatient care during the previous six months (43 percent). Home health care often represented a long-term intervention: 61 percent of the visits were to enrollees who received home health care for six months or more. We could find no evidence that home health care was substituted for hospital care; the metropolitan statistical areas with higher rates of home health care did not have fewer hospital admissions or shorter lengths of stay. There was more geographic variation in the use of home health care than in the use of other major categories of Medicare services (e.g., hospital admissions and physicians' services). Five states (all in the South) had more than 9000 visits per 1000 enrollees, and 14 states had fewer than 3000 visits per 1000 enrollees.

Conclusions Home health care visits are used primarily to provide long-term care. There is no evidence that services provided at home replace hospital services, and the dramatic geographic variation in home visits suggests a lack of consensus about their appropriate use.

Source Information

From the Veterans Affairs Medical Center, White River Junction, Vt. (H.G.W.); the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, N.H. (H.G.W., D.E.W.); the Maine Medical Assessment Foundation, Augusta (D.E.W.); Maine Medical Center, Portland (D.E.W.); and the Urban Institute, Washington, D.C. (W.P.W.). The views expressed here are those of the authors and do not necessarily represent the views of the institutions with which they are affiliated.

Address reprint requests to Dr. H.G. Welch at the Veterans Affairs Outcomes Group (111B), Veterans Affairs Medical Center, White River Junction, VT 05009.

Full Text of this Article

Related Letters:

Medicare Home Health Care Services
Feldman P. H., Bishop C. E., Rothberg E., Treml J., Deady E., de Ipolyi P. D., Wennberg D. E., Welch H. G.
Extract | Full Text  
N Engl J Med 1997; 336:226-228, Jan 16, 1997. Correspondence

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