The authors examine the historical origins and actual circumstances of home health care and its delivery in the United States, focusing on the major beneficiaries of the system--the elderly. Cost containment policies applied in hospital settings and the residual effects of these policies in the home health care arena are discussed in anticipation of a prospective payment system for home health care. A data-based study of acutely ill recipients of home health care revealed that the severity of illness of patients receiving home health care increased after the implementation of the hospital-based prospective payment system, but the level of home care remained in a steady-state.



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