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Related Experiment Videos

Home and community-based waivers for disabled adults: program versus selection effects.

Courtney Harold Van Houtven1, Marisa Elena Domino

  • 1Department of Medicine, Duke University Medical Center, Durham, NC, USA. courtney.vanhoutven@duke.edu

Inquiry : a Journal of Medical Care Organization, Provision and Financing
|July 16, 2005
PubMed
Summary

Participation in Medicaid home and community-based waivers reduced nursing home and hospital costs for blind or disabled adults. While total costs did not decrease, the program achieved its goals of shifting care away from facilities.

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Area of Science:

  • Health Economics
  • Public Health Policy
  • Gerontology

Background:

  • Medicaid home and community-based waivers aim to provide alternatives to institutional care.
  • Understanding expenditure changes is crucial for evaluating waiver program effectiveness.
  • Distinguishing selection effects from true program impacts is a key challenge.

Purpose of the Study:

  • To determine if expenditure changes in Medicaid waivers are due to participant selection or actual program effects.
  • To analyze the impact of home and community-based waivers on healthcare expenditures for disabled or blind adults.

Main Methods:

  • Utilized North Carolina Medicaid claims data from fiscal years 1998-2000.
  • Employed two-part expenditure models for nursing home, inpatient, and total costs.

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  • Applied instrumental variables estimation to control for selection bias into the waiver program.

    • Main Results:

    • No overall savings in total healthcare expenditures were observed for waiver participants.
    • Significant reductions were found in nursing home expenditures among waiver participants.
    • Hospital inpatient expenditures also decreased significantly for individuals in the home and community-based waiver program.

    Conclusions:

    • The home and community-based waiver program successfully reduced specific high-cost institutional care expenditures.
    • The findings suggest that waivers can achieve their goals of facilitating community-based care, despite not lowering overall costs in this cohort.
    • Policy implications favor the continued support and expansion of such waiver programs for eligible populations.