Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112090

Bruce Friedman, PhD, Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 273-2618, Bruce_Friedman@urmc.rochester.edu

In the U.S. several models of Medicare-funded Long Term Care have been tested in Demonstration projects sponsored by the Health Care Financing Administration/Centers for Medicare and Medicaid Services. One such Demonstration was ACCESS:Medicare (1982-1986). It featured a 100-day nursing home and 100-day home care benefit with waivers of Medicare's skilled care criteria and its requirement for a 3-day hospital stay prior to receipt of Skilled Nursing Facility (SNF) care. Compared to a Comparison group, the Demonstration patients who were eligible for Medicare but not Medicaid experienced fewer hospital days per person per year (44 vs. 59) and shorter average length of stay (11 days vs. 18.5). These were achieved through a greater proportion of the Demonstration participants using SNF care (44% vs. 16%), more SNF days per person per year (54 vs. 11), a higher proportion using home health care (71% vs. 39%), and more home health days per person per year (104 vs. 32). Total public (Medicare and Medicaid) expenditures were 24% higher for the Demonstration patients than for the Comparison group. The patients who were enrolled in both Medicare and Medicaid experienced fewer hospital days per person per year (13 vs. 61). This was achieved through a larger proportion of the Demonstration participants using SNF care (68% vs. 59%), more SNF days (176 vs. 156), and a higher proportion using home health care (51% vs. 39%). Total public expenditures were 28% lower for the Demonstration patients. Policy implications for Medicare coverage of Long Term Care will be explored.

Learning Objectives:

• The participants in the session will acquire information about how a Medicare Demonstration with a limited long term care benefit was structured, as well as how the Demonstration affected health care use and costs, including Medicare and Medicaid costs.
• The participants in the session will be able to identify and describe the benefit structure of a Medicare Demonstration project with a limited long term care benefit as well as health care use and costs, including Medicare and Medicaid costs, experienced by the participants in the Demonstration.

Keywords: Long-Term Care, Financing

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation