This study investigates differences in satisfaction and quality of life for Medicare beneficiaries using home health care services before and after implementation of the Interim Payment System (IPS) as part of the Balanced Budget Act (BBA) of 1997. Data are from surveys conducted pre- and post-BBA. Multivariate analyses estimate the effect of being in the post-BBA period controlling for beneficiary, agency, and community characteristics. Sixteen dependent variables measure satisfaction with the agency, and two measure life quality. Despite dramatic utilization decreases, differences were not found for overall agency satisfaction, satisfaction with discharge, or with the nursing and therapist care received. Decreases in satisfaction were found for some interpersonal aspects of staff interaction and, for the group of respondents who received services in the agencies that participated in both the pre- and postperiods, with the decreasedprovision of personal care services. A large increase was found in staff encouraging independence.
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