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- W3199536596 abstract "Nursing home residents in the United States arefrequently hospitalized. Such hospitalizations are costly, many areconsidered unnecessary and lead to further health deterioration.Controlling for health status, Medicaid residents have been foundto have a higher risk of hospitalization than private-payresidents, but the reasons for this difference are not clear. Thehigher rate of hospitalization may be caused by within-facilitydisparities between Medicaid and private-pay residents.Alternatively, it may also be caused by across-facility variations,whereby facilities with a higher proportion of Medicaid residentsmay be more likely to hospitalize their residents than facilitieswith lower proportion of Medicaid residents. This dissertation aimsto disentangle the within-facility disparities from theacross-facility variations in hospitalization risks betweenMedicaid and private-pay residents, and to investigate the impactof financial incentives. Multiple datasets from four states(California, New York, Ohio, and Texas) for calendar year 2003 areemployed in this study. The study sample includes all eligiblelong-term care residents with either Medicaid or private payerstatus. The unit of analysis is the individual resident withhospitalization as the dependent variable (dichotomous). Individualpayer status and facility payer-mix are the main variables ofinterests. Additional covariates include individual risk factors,co-morbidities, facility characteristics, and market level factors.Several logit models are fit to investigate payer-relatedwithin-facility disparities versus across-facility variations.Analyses are stratified by state and ownership, and responses tofinancial incentives are tested statistically to make inferencesabout hypotheses regarding Medicaid bed-hold polices and for-profitversus not-for-profit responses to incentives. Furthermore,hospitalization rates for Medicaid and private-pay residents arecompared across the four states by using standard populations. Results show that Medicaid residents are more likely to behospitalized than private-pay residents, controlling for individualrisk factors. Higher hospitalization rates experienced by Medicaidresidents can be attributed to both within-facility disparities andacross-facility variations. Payer-related within-facilitydisparities in hospitalization risks exist in most facilities, andare modified by facility characteristics (e.g. ownership) and stateMedicaid policies (e.g. bed-hold policy). Across-facilityvariations are also detected in most of the facilities. Nursinghomes with a higher concentration of Medicaid residents are morelikely to hospitalize their residents, regardless of the residents’payer status. In addition, hospitalization rates for Medicaid andprivate-pay residents are found to vary across states. Inconclusion, this dissertation finds that for-profit facilities aremore likely to be affected by financial incentives thannot-for-profit facilities with respect to hospitalizationdecisions. Bed-hold policy…" @default.
- W3199536596 created "2021-09-27" @default.
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- W3199536596 date "2010-01-01" @default.
- W3199536596 modified "2023-09-23" @default.
- W3199536596 title "Hospitalization Risks in Nursing Homes: Does Payer SourceMatter?" @default.
- W3199536596 hasPublicationYear "2010" @default.
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