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Determinants of Medicare Home Healthcare Service Use Among Medicare Recipients

BackgroundMedicare reimbursement for home healthcare (HHC) services has changed dramatically in recent years. A clear understanding of the determinants of Medicare HHC services use is needed so that HHC agencies can meet the demand for services from an aging population while remaining financially sound. ObjectivesThe purpose of the study was to identify the determinants of Medicare HHC service within the framework of the Andersen Behavioral Model. MethodsThis cross-sectional secondary analysis used data from the 1996 Medical Expenditures Panel Survey to examine characteristics of 239 subjects who had received Medicare reimbursed HHC services. Predisposing characteristics, enabling resources, and need characteristics were examined to explain Medicare HHC service use. Two criterion measures, annual Medicare expenditures and days of care, were employed in hierarchical regression analyses. ResultsVariance in annual Medicare expenditures was explained by both the predisposing (R2 = .16, p < .001) and need characteristics (R2 = .09, p < .001). Variance in days of care was explained by predisposing characteristics (R2 = .12, p < .001) and need characteristics (R2 = .15, p < .001). The adjusted R2 for the total model was .21 for annual Medicare expenditures and .25 for days of care. ConclusionsWhile Andersen’s Behavioral Model is useful in explaining Medicare HHC service use, it may be important to use multiple measures as criterion variables since the amount and proportion of variance explained differs with the variable used.