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- Title
The Role of Medicare's Inpatient Cost-Sharing in Medicaid Entry.
- Authors
Keohane, Laura M.; Trivedi, Amal N.; Mor, Vincent
- Abstract
<bold>Objective: </bold>To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries.<bold>Data Sources: </bold>Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators.<bold>Study Design: </bold>Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge. In a regression discontinuity analysis, we take advantage of this Medicare benefit feature to test whether beneficiaries with greater cost-sharing have higher rates of Medicaid enrollment.<bold>Data Extraction Methods: </bold>We identified 221,248 Medicare beneficiaries with an initial hospital stay and a readmission 53-59 days later (no deductible) or 60-66 days later (charged a deductible).<bold>Principal Findings: </bold>Among beneficiaries in low-socioeconomic areas with two hospitalizations, those readmitted 60-66 days after discharge were 21 percent more likely to join Medicaid compared with those readmitted 53-59 days following their initial hospitalization (absolute difference in adjusted risk of Medicaid entry: 3.7 percent vs. 3.1 percent, p = .01).<bold>Conclusions: </bold>Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation.
- Subjects
UNITED States; MEDICARE; COST shifting; REGRESSION analysis; DATA extraction; NURSING care facilities; ECONOMIC statistics; INSURANCE; ECONOMIC impact; INSURANCE statistics; MEDICAID statistics; COMPARATIVE studies; ECONOMICS; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH funding; RESIDENTIAL patterns; SOCIOECONOMIC factors; EVALUATION research; PATIENT readmissions
- Publication
Health Services Research, 2018, Vol 53, Issue 2, p711
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.12682