Wayne L. Anderson

Estimates of state-level health-care expenditures associated with disability.

Objectives. We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. Methods. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002–2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. Results. The DAHE for all U.S. adults totaled

Disability status, mortality, and leading causes of death in the United States community population

397.8 billion in 2006, with state expenditures ranging from

Medicare maximization by state Medicaid programs: effects on Medicare home care utilization.

598 million in Wyoming to

Making the System Work for Home Care Quality

40.1 billion in New York. Of the national total, the DAHE were

Adoption of Retrospective Medicare Maximization Billing Practices by State Medicaid Home Care Programs

118.9 billion for the Medicare population,

Qualitative analysis and conceptual mapping of patient experiences in home health care

161.1 billion for Medicaid recipients, and

Are Consumer-Directed Home Care Beneficiaries Satisfied? Evidence From Washington State

117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. Conclusions. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

Workforce issues and consumer satisfaction in Medicaid personal assistance services.

Objective:We examined the effect of functional disability on all-cause mortality and cause-specific deaths among community-dwelling US adults. Methods:We used data from 142,636 adults who participated in the 1994–1995 National Health Interview Survey-Disability Supplement eligible for linkage to National Death Index records from 1994 to 2006 to estimate the effects of disability on mortality and leading causes of death. Results:Adults with any disability were more likely to die than adults without disability (19.92% vs. 10.94%; hazard ratio=1.51, 95% confidence interval, 1.45–1.57). This association was statistically significant for most causes of death and for most types of disability studied. The leading cause of death for adults with and without disability differed (heart disease and malignant neoplasms, respectively). Conclusions:Our results suggest that all-cause mortality rates are higher among adults with disabilities than among adults without disabilities and that significant associations exist between several types of disability and cause-specific mortality. Interventions are needed that effectively address the poorer health status of people with disabilities and reduce the risk of death.

Medicaid Spend Down: New Estimates and Implications for Long- Term Services and Supports Financing Reform

Medicaid programs in some states have attempted to shift home health care costs to Medicare by using retrospective billing practices. The authors explored whether retrospective billing practices increase Medicare utilization for dual eligibles by analyzing primary data on the existence of retrospective billing practices collected from 47 state Medicaid offices complemented with individual-level secondary data from the 1992-1997 Medicare Current Beneficiary Survey. An individual-level random effects model was used to estimate the increase in the probability and amount of Medicare home care visits from state retrospective billing practices. Retrospective billing practices were found not to affect either the probability or the amount of Medicare home care visits in these data, but the significant inverse relationship found between Medicaid and Medicare visits shows that states with high Medicaid utilization have opportunity to shift some of these visits to Medicare.

Work-related injuries among certified nursing assistants working in US nursing homes

Abstract: The post‐acute and long‐term care systems are changing rapidly, with an increasingly important role being played by home care. Under the current system, home care does not consistently meet the needs of older people living in the community. This problem is caused, in large part, by the existing system of financing and regulating home care. This paper examines how the current system funded by Medicare, Medicaid, state programs, private insurance, and out‐of‐pocket spending affects the delivery and quality of home care services. Specifically, this paper analyzes how financing, coverage of services, reimbursement, quality regulation and assurance, and information coordination affects the quality of home care. The paper concludes by drawing implications for policy.