Provider incentive payments in the Medicaid program have been in operation nationally since the early 1980s. Although initially indicating favorable results, recently the ability of such incentives to produce the desired action has been questioned. This study examined the Florida Medicaid AIDS Nursing Home Admission Incentive Program to determine the reasons behind the program's apparent inability to increase Medicaid-covered persons with AIDS (PWAs) admissions to nursing homes. A survey of 308 nursing homes in the 10 Florida counties with the highest cumulative AIDS cases in the state was conducted. The results reveal that (a) the level of incentive reimbursement received, (b) the financial classification of existing (non-AIDS) residents, and (c) the level of technological sophistication of the facility are all significantly related to the number of PWAs admitted. Based on these results, the author discusses implications for the future of Medicaid incentive programs for PWAs.
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References
1.
Afzal, N.
, & Wyatt, A. (1989). Long-term care of AIDS patients. Quality Review Bulletin, 15(1), 20-25.
2.
AIDS Task Force
(1993). Committee meeting transcript, March 4, 1993. Orange County, FL: Orlando Regional Medical Center.
3.
Babbie, E.
(1989). The practice of social research. Belmont, CA: Wadsworth.
4.
Benjamin, A.
(1988). Long-term care for people with HIV/AIDS: Perspectives from experience with the elderly. Milbank Quarterly, 66(3), 415-443.
5.
Buchanan, R.
, Madel, R., & Persons, D. (1991). Medicaid payment policies for nursing home care: A national survey. Health Care Financing Review, 13(1), 55-72.
6.
Chroman, M.
(1989). Meeting the needs of AIDS patients: A study of the role of nursing homes in Los Angeles county (Masters thesis, California State University, Long Beach, 1989). Dissertation Abstracts International, 28, 64-64.
7.
Cruise, P.
(1993). AIDS and long-term care: An examination of Florida's medicaid nursing home incentive program. AIDS Patient Care, 8(3), 121-126.
8.
Davidson, S.
(1982). Physician participation in medicaid: Background and issues. Journal of Health Politics, Policy and Law, 6(4), 703-717.
9.
El-Sadr, W.
, Oleske, J., Agins, B., Bauman, K., Brosgart, C., Brown, G., Geaga, J., Greenspan, D., Hein, K., Holzemer, W., Jackson, R., Lindsay, M., Makadon, H., Moon, M., Rappoport, C., Scott, G., Shervinton, W., Shulman, L., & Wofsy, C. (1994). Evaluation and management of early HIV infection (AHCPR Publication No. 94-0572). Rockville, MD: Agency for Health Care Policy and Research.
10.
Fanning, T.
, & de Alteriis, M. (1993). The limits of marginal economic incentives in the medicaid program: Concerns and cautions. Journal of Health Politics, Policy and Law, 18(1), 27-42.
11.
Florida Agency for Health Care Administration [AHCA]
. (December, 1992). Nursing home reporting system: Annual report. Tallahassee, FL: Agency for Health Care Administration.
12.
Florida Department of Health & Rehabilitative Services [HRS]
. (November, 1992). The Florida HIV/AIDS monthly surveillance report. Tallahassee, FL: Florida Department of Health & Rehabilitative Services.
13.
Florida Long-Term Care Reimbursement Plan
. (April 13, 1993). Florida Title XIX long-term care reimbursement plan, version VIII. Tallahassee: Florida Department of Health & Rehabilitative Services.
14.
Fossett, J.
, & Peterson, J. (1989). Physician supply and Medicaid participation: The causes of market failure. Medical Care, 27(4), 386-396.
15.
Gentry, D.
, Fogarty, T., & Lehrman, S. (1994). Providing long-term care for persons with AIDS: Results from a survey of nursing homes in the United States. AIDS Patient Care, 8(3), 130-137.
16.
Gray, V.
, Jacob, H., & Albritton, R. (1990). Politics in the American states: A comparative analysis. Glenview, IL: Scott, Foresman.
17.
Green, J.
, & Arno, P. (1990). The "medicaidization" of AIDS. Journal of the American Medical Association, 264(10), 1261-1266.
18.
Hartwig, F.
, & Dearing, B. (1979). Exploratory data analysis. Beverly Hills, CA: Sage.
19.
Hellinger, F.
(1991). Forecasting the medical care costs of the HIV epidemic: 1991-1994. Inquiry, 28(4), 213-255.
20.
Hellinger, F.
(1993). The lifetime cost of treating a person with HIV. Journal of the American Medical Association, 270(4), 474-478.
21.
Jellinek, P.
(1988). Case-managing AIDS. Issues in Science and Technology, 4(1), 59-63.
22.
Koch, A.
(1992) Long-term care for people with HIV/AIDS: Challenges and opportunities. Journal of Health Administration Education, 10(1), 113-128.
23.
Lincoln, Y.
, & Guba, E. (1985). Naturalistic Inquiry. Beverly Hills, CA: Sage.
24.
Linsk, N.
, & Marder, R. (1992). Medical social work long-term care referrals for people with HIV infection. Health and Social Work, 17(2), 105-115.
25.
Mason, K.
(1992). Caring for people with AIDS. Provider, 18(2), 32-32.
26.
Meiners, M.
, Thorburn, P., Roddy, P., & Jones, B. (1985). Nursing home admissions: The results of an incentive reimbursement experiment (DHHS Publication No. PHS 86-3397). Rockville, MD: National Center for Health Services Research and Health Care Technology Assessment.
27.
Mulaney E.
(1989). A model of nursing home provider response to medicaid incentive reimbursement (Doctoral dissertation, George Washington University, 1989). Dissertations Abstracts International, 50, 2979-2979.
28.
Pascal, A.
, Cvitanic, M., Bennett, C., Gorman, M., & Serrato, C. (1989). State policies and the financing of acquired immunodeficiency syndrome. Health Care Financing Review, 11(1), 91-104.
29.
Patton, M.
(1980). Qualitative evaluation methods. Beverly Hills, CA: Sage.
30.
Perloff, J.
, Kletke, P., & Neckerman, K. (1986). Recenttrends in pediatric physician participation in medicaid. Medical Care, 24(12), 749-760.
31.
Richardson, H.
(1990). Long-term care. In A. Kovner (Ed.), Health care delivery in the United States (pp. 175-208). New York: Springer.
32.
Scitovsky, A.
(1989). Past lessons and future directions: The economics of health services delivery for HIV-related illnesses. In W. LeVee (Ed.), New perspectives on HIV-related illnesses: Progress in health services research (pp. 23-47). Rockville, MD: National Center for Health Services Research and Health Care Policy Assessment.
33.
Silverman, M.
(1988). AIDS care: The San Francisco model. Journal of Ambulatory Care Management, 11(1), 14-18.
34.
Taravella, S.
(1990, March 5). AIDS: Will rising demand overcome reluctance?Modern Healthcare, 12-19.
35.
Taravella, S.
(1992, June 22). Innovative nursing facility scheduled to open in Seattle. Modern Healthcare, 42-42.
36.
United States Conference of Mayors AIDS/HIV Program
. (1990, April). The impact of AIDS upon America's cities. AIDS Information Exchange, 7(2).
37.
U.S. General Accounting Office
(1988). Long-term care for the elderly (GAO Report No. HRD-89-4). Gaitherburg, MD: Author.
38.
Yin, R.
(1989). Case study research. Newbury Park, CA: Sage.
