[영문]We trace key policy changes that affected use of the Medicare homehealth benefit from the 1980s through the prospective paymentsystem implemented in 2000, analyzing the impact on three measuresof home care use: expenditures, users and visits. We demonstratethe impact of policies generated in the legislative, the judicial,and the executive branches of government and the gamingbehavior of home health agencies in response to policy changes.Our analysis suggests that the policy itself and the implementationprocess are critical to understanding benefit use. The incentivesin the policies and agency reactions had the potential to generatefraud in two directions, either over or underuse. Throughoutthis history, use of the benefit was driven less by patient need thanby arbitrary interpretations of eligibility. These interpretationswere in turn influenced by opposing ideologies favoring redistributionbased on market principles versus those based on need.