Grabowski D, Morrisey M, Ohsfeldt R; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 99.

University of Alabama at Birmingham, RPHB 330, 1530 3rd Avenue S, Birmingham, Alabama 35294-0022, Phone: (205) 975-8967, Fax: (205) 934-3347, E-mail: grabowski@uab.edu

RESEARCH OBJECTIVE: Certificate-of-need (CON) programs have been widely used to control the growth in nursing homes and thereby limit state Medicaid expenditures. However, CON policies have been found to be associated with lower nursing home quality and restricted access to services for Medicaid recipients. In recent years, a number of states have repealed their CON laws as they apply to nursing homes. This study examined the effects of these CON repeals on Medicaid long-term care expenditures.STUDY DESIGN: We estimated a set of regression equations using a pooled time series of state level Medicaid long-term care expenditures from the period 1981 through 1998. The analysis is complicated by the fact that CON repeals and other Medicaid programmatic variables are simultaneously determined with Medicaid expenditure levels. Thus, we estimated both a simple one equation model and a two-stage least squares model, which accounts for the simultaneity issue.PRINCIPAL FINDINGS: Using either a simple one equation model or the more complex multi-equation approach, preliminary analyses provided no evidence that Medicaid long term care expenditures increased when CON laws were repealed. In fact, our analyses indicated that CON repeal was associated with lower Medicaid expenditures. The data also suggested that it has been the level of Medicaid nursing home payment that has been the policy variable responsible for lower Medicaid expenditures.CONCLUSIONS: This paper provided evidence that the repeal of CON legislation has not led to significantly higher Medicaid long-term care expenditures. Implication for Policy, Delivery, or Practice: There is a large literature that concludes hospital CON laws are ineffective at constraining public expenditures. Nevertheless, Medicaid policymakers have always assumed that CON reduced nursing home expenditures. This study suggests that state Medicaid programs may wish to re-visit the use of CON programs as they pertain to nursing homes.

Publication Types:

• Meeting Abstracts

Keywords:

• Health Expenditures
• Health Services Needs and Demand
• Insurance, Long-Term Care
• Legislation
• Long-Term Care
• Medicaid
• Nursing Homes
• economics
• legislation & jurisprudence
• hsrmtgs

Other ID:

• GWHSR0001672

UI: 102273348

From Meeting Abstracts