Effects of the 1997 Balanced Budget Act on Venipuncture Beneficiaries

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Abstract
This study assesses the effects on patients and their caregivers of denying venipuncture as a home health services qualifier. Primary data were developed from medical records and 6-month recall interviews of disqualified recipients and their caregivers in Tennessee, a state without community-based long-term care. Effects of disqualification on patients' health status, activities of daily living (ADLs), instrumental activities of daily living (IADLs), mental status, and transportation costs were analyzed. Those disqualified do more self-bathing and dressing, rely more on caregivers for other ADLs and IADLs, exhibit a high incidence of depression, and some incur additional costs. Following disqualification, caregivers assist much more with ADLs, incurring a greater burden than patients acknowledge and increased implicit work costs and out-of-pocket costs for care and transportation. Secondary effects of this major policy change were substantial for Tennessee residents. Before implementation, testing the effects of such a major policy change for elderly with and without community-based long-term care would have been prudent.

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