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.
We acknowledge the following organizations that provided support for this research: The John A. Hartford Foundation, The Andrus Foundation and the Centers for Medicare and Medicaid Services.
Notes
1. Census regions: 1. New England - Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont; 2. Middle Atlantic - New Jersey, New York, Pennsylvania; 3. East North Central - Illinois, Indiana, Michigan, Ohio, Wisconsin; 4. Puerto Rico; 5. South Atlantic - Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia; 6. East South Central - Alabama, Kentucky, Mississippi, Tennessee; Puerto Rico; 7. West South Central - Arkansas, Louisiana, Oklahoma, Texas; 8. Mountain - Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming; 9. Pacific - Alaska, California, Hawaii, Oregon, Washington; 10. West North Central - Iowa, Kansas, Minnesota, Missouri, Nebraska, N. Dakota, S. Dakota.