title: Differences across payors in charges for agency-based home health services: evidence from the National Home and Hospice Care Survey.
abstract: OBJECTIVE
  To investigate charge and payment differentials for home health services across different payors.
  
  
  METHODS
  The 1992 National Home and Hospice Care Survey, a nationally representative survey of home and hospice care agencies and their patients, collected by the National Center for Health Statistics.
  
  
  METHODS
  We compare the average charge for a Medicare home health visit to the average charge for patients with other sources of payment. In making such comparisons, we control for differences across payors in service mix and agency characteristics.
  
  
  RESULTS
  Agencies charge various payors different amounts for similar services, and Medicare is consistently charged more than other payors.
  
  
  CONCLUSIONS
  Findings imply the potential existence of payment differentials across payors for home health services, with Medicare and privately insured patients likely to be paying more than others for similar services. Such conclusions raise the possibility that, as in other segments of the healthcare market, cost-shifting and price discrimination might exist within the home health industry. Future research should explore these issues, along with the question of whether Medicare is paying too much for home health services.
authors.affiliation: RAND, Washington, DC 20005, USA. vicki_freedman@rand.org
authors.forename: V A
authors.initials: VA
authors.lastname: Freedman
authors.forename: J D
authors.initials: JD
authors.lastname: Reschovsky
mesh_terms: D005249:Fees and Charges / Q000706:statistics & numerical data*; D019538:Health Care Surveys / Q000191:economics* / Q000706:statistics & numerical data; D018574:Home Care Agencies / Q000191:economics* / Q000706:statistics & numerical data; D018575:Home Care Services, Hospital-Based / Q000191:economics / Q000706:statistics & numerical data; D017051:Hospice Care / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D012044:Regression Analysis; D014481:United States