Medicare home health agency utilization, 1984-1994

This study analyzes the determinants of Medicare home health agency (HHA) u se in 1984, 1989, and 1994. We estimated a two-part model, modified to adju st for heteroskedasticity, using data from the National Long-Term Care Surv eys and the sample members' Medicare claim files. We found an evolving patt ern of determinants of Medicare HHA utilization. The rapid increase in use after HHA guideline revisions in 1989 was associated closely with rising im portance of limitations in activities of daily living and instrumental acti vities of daily living as determinants of expected utilization. Our results show little evidence that Medicare home health services substitute for inf ormal home care, though they may reduce the use of skilled nursing facility care.