Impact of Medicare payment policy on home health resources utilization

Health Care Financing Review, Wntr, 1991 by Audrey Irvine, Elayne Kornblatt Phillips, Patricia Cloonan, James C. Torner, Mary E. Fisher, Gary A. Chase

A note should be made regarding the percent of elderly patients without Medicare being seen through the public health department. The traditional mission of the public health department has been the provision of health care to the indigent. Under the fiscal conservatism of the last decade, however, public home health has been told to compete in the marketplace and pay its own way. Previously, the health department was able to do this by balancing the cost of caring for the indigent with paying patients. The recent expansion of private home health care, however, has cut deeply into the availability of paying patients, tipping the fiscal balance and putting many public home health services out of business. Data presented in this article suggest that the public health departments are seeing these patients in approximately 10 times the number that the national average of elderly without Medicare would indicate. Approximately two-thirds of these patients do not have any source of payment.

If public home health is mandated to compete in the marketplace for its survival, then the playing field must be leveled. A possible alternative is to require all home health agencies to accept a percent of the indigent, as is done in many hospitals. On the other hand, State health departments could return to the historical mission of providing indigent care. This would allow the private industry to continue referring the indigent case load, ensuring care for the poor elderly despite fluctuations in the market. Such a decision will, however, require a commitment on the part of our communities to allocate the needed resources for this care.

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