Using the 1992 National Home and Hospice Care Survey, a representative survey of home and hospice care agencies and their patients, the authors investigated charge and payment differentials for home health services across different payors. They compared the average charge for a Medicare home health visit to the average charge for patients with other sources of payment, controlling for differences across payors in service mix and agency characteristics. Results indicated that agencies charge various payors different amounts for similar services, and Medicare is consistently charged more than other payors. This implies the potential existence of payment differentials across payors for home health services, with Medicare and privately insured patients likely to be paying more than others for similar services. Such conclusions raise the possibility that, as in other segments of the healthcare market, cost-shifting and price discrimination might exist within the home health industry. Future research should explore these issues, along with the question of whether Medicare is paying too much for home health services.
Originally published in: Health Services Research, v. 32, no. 4, October 1997, pp. 433-452.
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