Date of Award

2012

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Health Professions

First Advisor

Charles Ellis

Second Advisor

Heather S. Bonilha

Third Advisor

Abby Swanson Kazley

Fourth Advisor

James S Zoller

Abstract

This study uses Medicare claims from 1997 and 2004 to examine two important health policy issues using patients with ischemic stroke as an example. We explore the differences in rehabilitation services utilization and expenditures for stroke prior to and after outpatient rehabilitation caps were enacted. We then examine the effect of using a total cost approach versus a marginal cost method to estimate the first year cost of stroke and stroke rehabilitation. We found the cap did constrain outpatient rehabilitation utilization and cost of rehabilitation services if examined only using Medicare Part B provider costs, but not when facility costs were also included. Use of a marginal costing approach was superior to average costing. Indeed, the average costing approach may be expected to inflate the estimated 2004 SC total cost due to stroke for Medicare patients by $3.6 billion, because this approach ascribes expenditures for comorbid conditions to stroke.

Rights

All rights reserved. Copyright is held by the author.

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