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BASIC STATISTICS ABOUT HOME CAREHome care in the United States is a diverse and dynamic service industry. More than 20,000 providers deliver home care services to some 7.6 million individuals who require services because of acute illness, long-term health conditions, permanent disability, or terminal illness. Annual expenditures for home health care are projected to be $41.3 billion in 2001. HOME CARE PROVIDERSThe first home care agencies were established in the 1880s. Their number grew to some 1,100 by 1963 and to more than 20,000 currently. Home health agencies, home care aide organizations, and hospices are known collectively as "home care organizations." Medicare-certified Agencies Home care agencies of various types have been providing high-quality, in home services to Americans for more than a century. However, Medicare's enactment in 1965 greatly accelerated the industry's growth. Medicare made home care services, primarily skilled nursing and therapy, available to the elderly. In 1973, these services were extended to certain disabled younger Americans. Between 1967 and 1985, the number of agencies certified to participate in the Medicare program grew by more than three-fold, from 1,753 to 5,983. In the mid-1980s, the number of Medicare-certified home care agencies leveled off at around 5,900 as a result of increasing Medicare paperwork and unreliable payment policies. These problems led to a lawsuit brought against the Health Care Financing Administration (HCFA) in 1987 by a coalition of US Congress Members led by Reps. Harley Staggers (D-WV) and Claude Pepper (D-FL), consumer groups, and the National Association for Home Care (NAHC). The successful conclusion of this lawsuit gave NAHC the opportunity to participate in rewriting the Medicare home care payment policies. Following these revisions, Medicare's annual home care benefit increased significantly and the number of home care agencies had risen to over 10,000. More recently, the number of Medicare-certified home health agencies declined to 7,152. NAHC believes the 31.5% decline in agencies since 1997 is the direct result of changes in Medicare home health reimbursement enacted as part of the Balanced Budget Act of 1997 (P.L. 105-33). The number of hospital-based and freestanding proprietary agencies has grown faster than any other type of certified agency since the coverage clarifications took effect. Freestanding proprietary agencies comprise 40% and hospital-based agencies 30% of Medicare-certified agencies. This differs markedly from the industry composition in the early 1980s, when public health agencies dominated the ranks of certified agencies and proprietary and hospital-based agencies combined accounted for only one-fourth of the total. Table 1 shows the changes over time in types of agencies participating in Medicare. |
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