Home Health Care Nurses

POLITICS BEHIND HOME HEALTH CARE CHANGES IN THE

BALANCED BUDGET ACT: A POLICY ANALYSIS

FOR COMMUNITY HEALTH NURSES WORKING IN HOME HEALTH CARE

The elderly is the fastest growing population in the United States; indeed, it is estimated that by 2010, people aged 65 years and older will comprise almost 14 percent of the American population (FedStats, 1998). Although most people aged 65 years and older need relatively little medical care, many do have health problems. In this regard, Papalia and Olds (1995) report that about 10 percent of older Americans (most of whom are 85 or older) are ill, disabled and isolated and very much in need of home health care. As the American population continues to gray, the number of older persons needing home health care is going to continue to increase, and so are health care costs (Papalia & Olds, 1995).

However, some very real policy and operation changes were introduced into the home health care industry as a result of the passage of the Balanced Budget Act of 1997 (BBA). These changes included but were not limited to: IPS for home health, per-visit cost limits; an aggregate per-beneficiary annual limit and home health prospective payments based on the site of services. The issue examined in the policy analysis presented here involved an examination of the sources behind the home health care changes mandated by the Balanced Budget Act of 1997 in order to determine whether each source operated to hinder or facilitate

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areas of assessment, planning, and treatment---and to do so in a manner that is both time and cost efficient as well as profitable. Thus, it can be asked as to what extent politicians as a source of health care changes mandated by the BBA operated to facilitate or hinder these goals? With respect to the foregoing, both Forester (1998) and Ettinger (1998) report that the central motivation of most politicians as to the provisions of the BBA was to find an alternative to the traditional cost-based payment approach to home health care. Forester (1998) states that this desire has been a central concern of both democrats and republicans for years and has been discussed and studied by both parties when they were in control of Congress. In other words, it is not just a "Republican" budgetary agenda. Both political parties had concerns and the concerns themselves were motivated by the ongoing growth of the home health care industry over the last several decades and by the phenomenal growth that is expected to occur when "baby boomers" reach retirement age. Politicians, of course, are the single greatest contributory source to the BBA as they actually wrote and passed the BBA. And, in general, the results of their influence are, acc

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