Comparison of services among different types of home health agencies

Past and proposed public policy reforms in home care have presumed that similar services are provided by different types (e.g., public, proprietary) of home health agencies under a uniform benefit. To examine this presumption, the author used Medicare billing data and interview information for a nationally representative sample of 921 home health patients from the 1984 National Long Term Care Survey, supplemented with data on agency type from the Health Care Financing Administration. In multivariate linear regression models that included patient demographics, marital status, insurance status, living arrangement, urban/rural location, informal support, and functional status, patients of public home health agencies and Visiting Nurse Associations (VNAs) had lower total charges and fewer visits per episode of enrollment than patients of hospital-based, private nonprofit, or proprietary agencies. Public home health agency patients had the lowest and proprietary agency patients the highest number of visits per week of enrollment. Model R2 ranged from 0.13 to 0.22. These results indicate that, for example, similar patients could be expected to incur nearly four times the total charges, and receive three times the total visits and twice the number of visits per week at proprietary as compared with public home health agencies. Patients enrolled in home health agencies with greater incentives to generate revenue incurred more charges, and received more total and more frequent visits than patients enrolled in agencies that can cross-subsidize services. The amount of services and total cost of current proposals to expand the provision of supportive home care services may be strongly influenced by the implicit mix of provider types.