title: Determinants of Medicare home healthcare service use among Medicare recipients.
abstract: BACKGROUND
  Medicare reimbursement for home healthcare (HHC) services has changed dramatically in recent years. A clear understanding of the determinants of Medicare HHC services use is needed so that HHC agencies can meet the demand for services from an aging population while remaining financially sound.
  
  
  OBJECTIVE
  The purpose of the study was to identify the determinants of Medicare HHC service within the framework of the Andersen Behavioral Model.
  
  
  METHODS
  This cross-sectional secondary analysis used data from the 1996 Medical Expenditures Panel Survey to examine characteristics of 239 subjects who had received Medicare reimbursed HHC services. Predisposing characteristics, enabling resources, and need characteristics were examined to explain Medicare HHC service use. Two criterion measures, annual Medicare expenditures and days of care, were employed in hierarchical regression analyses.
  
  
  RESULTS
  Variance in annual Medicare expenditures was explained by both the predisposing (R(2) =.16, <.001) and need characteristics (R(2) =.09, <.001). Variance in days of care was explained by predisposing characteristics (R(2) =.12, <.001) and need characteristics (R(2) =.15, <.001). The adjusted for the total model was.21 for annual Medicare expenditures and.25 for days of care.
  
  
  CONCLUSIONS
  While Andersen's Behavioral Model is useful in explaining Medicare HHC service use, it may be important to use multiple measures as criterion variables since the amount and proportion of variance explained differs with the variable used.
authors.affiliation: Department of Nursing, Nebraska Methodist College, 8501 West Dodge Road, Omaha, NE 68114, USA. fhenton@methodistcollege.edu
authors.forename: Francese E
authors.initials: FE
authors.lastname: Henton
authors.forename: Bevely J
authors.initials: BJ
authors.lastname: Hays
authors.forename: Susan Noble
authors.initials: SN
authors.lastname: Walker
authors.forename: Jan R
authors.initials: JR
authors.lastname: Atwood
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D015984:Causality; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D019538:Health Care Surveys; D005102:Health Expenditures; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D008960:Models, Psychological; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012051:Reimbursement Mechanisms / Q000191:economics / Q000706:statistics & numerical data; D014481:United States