title: Use of Medicare services before and after introduction of the prospective payment system.
abstract: OBJECTIVE
  The case mix-adjusted pattern of use of health care services, especially posthospital care, is compared before and after the introduction of Medicare's Prospective Payment System (PPS).
  
  
  METHODS
  The 1982 and 1984 National Long Term Care Surveys (NLTCS) linked to Medicare administrative records 1982-1986 provide health and health service use data for 12-month periods before and after the introduction of PPS.
  
  
  METHODS
  Case-mix differences between pre- and post-periods are controlled by using the Grade of Membership model to identify health groups from the NLTCS data. Differences in timing (e.g., hospital length of stay) were controlled using life table models estimated for each health group, that is, service use patterns pre- and post-PPS are compared within groups.
  
  
  RESULTS
  Hospital LOS and admission rates declined post-PPS. Changes in the timing and location of death occurred but, overall, mortality did not increase. Changes in post-acute care service use by elderly, chronically disabled Medicare beneficiaries were observed: home health service use increased overall and among the unmarried disabled population.
  
  
  CONCLUSIONS
  PPS did not adversely affect quality of care as reflected in mortality or in hospital readmissions. Moreover, the differential use of post-acute care, and changes in hospital LOS by health group, indicate that the system responded, specific to marital status and age, to the severity of needs of chronically disabled persons.
authors.affiliation: Center for Demographic Studies, Duke University, Durham, NC 27708-0408.
authors.forename: K G
authors.initials: KG
authors.lastname: Manton
authors.forename: M A
authors.initials: MA
authors.lastname: Woodbury
authors.forename: J C
authors.initials: JC
authors.lastname: Vertrees
authors.forename: E
authors.initials: E
authors.lastname: Stallard
mesh_terms: D000367:Age Factors; D000368:Aged; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015993:Life Tables; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D016344:Medicare Part A / Q000706:statistics & numerical data*; D011445:Prospective Payment System / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D014481:United States