The demand for post-acute and chronic care in nursing homes.
OBJECTIVE
Nursing homes provide care for persons with both post-acute and chronic conditions. In general, these two types of patients are associated with short and long stays, respectively. They also tend to be covered by different public or private insurance plans. The author investigated whether and how the demand for these two types of nursing home care differ. How alternative definitions of post-acute and chronic care nursing home stays affect estimates also was explored.


METHODS
Data on a sample of elderly persons from the National Long-Term Care Channeling Demonstration was used. To account for market disequilibrium, demand was estimated using a bivariate probit with partial observability model.


RESULTS
Differences were found in the demand for the two types of nursing home care. For instance, economic factors and functional and cognitive limitations were relatively more important in the demand for nursing home care for chronic conditions. Further, chronic care patients appeared more likely to face problems of access into nursing homes. Classifying nursing home stays by payer, rather than by length of stay, captured expectations at admission and appeared to reflect consumer behavior better.


CONCLUSIONS
Differentiating post-acute and chronic care nursing home stays provides more meaningful information on consumer demand for nursing home care and will facilitate policy analysis in this area.
Reschovsky
J D
JD
Center for Studying Health Systems Change, Washington, DC 20024-2512, USA.
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data*; D006299:Health Services for the Aged; D006801:Humans; D019458:Insurance Coverage; D007353:Insurance, Long-Term Care / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D018803:Models, Economic; D009735:Nursing Homes / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D019467:Subacute Care / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States