Asunto(s)
Seguro de Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/economía , Anciano , Deducibles y Coseguros , Personas con Discapacidad , Anciano Frágil , Humanos , Seguro de Cuidados a Largo Plazo/estadística & datos numéricos , Medicaid , National Health Insurance, United States , Casas de Salud/economía , Estados UnidosRESUMEN
Long-term care represents a significant burden to the approximately 7 million elderly in need, their families, and the Medicaid program. Concerns exist about access, quality, cost, and the distribution of the burden of care. In this article each area is discussed, highlighting the principal issues, identifying the unique aspects that pertain to long-term care, and exploring the implications for research and policy development. Future trends, especially the growth of the elderly population, are expected to affect significantly the provision of long-term care. The considerable uncertainty about how these trends may impact on long-term care is described, and the critical role social choice will play in shaping the future long-term care system is emphasized.
Asunto(s)
Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud/estadística & datos numéricos , Cuidados a Largo Plazo/estadística & datos numéricos , Actividades Cotidianas , Factores de Edad , Anciano , Demografía , Predicción , Humanos , Calidad de la Atención de Salud , Estados UnidosRESUMEN
Data from the 1977 National Nursing Home Survey show that more than one fourth of admissions are discharged back to the community. Weighted logistical regression analysis was used to assess the impacts of patient, facility, and contextual characteristics on discharge status. The important exception is the proportion of the home's patients supported publicly, especially by Medicaid. Patients in homes that are heavily Medicaid supported have a significantly reduced chance of community discharge. Profit versus nonprofit status of the facility does not prove to be significant, nor does chain membership. Important patient characteristics are marital status, age, diagnosis, physical dependency, mental disorders, and source of payment for charges. Climate is significant, while occupancy rate is not.
Asunto(s)
Casas de Salud , Evaluación de Procesos y Resultados en Atención de Salud , Alta del Paciente , Factores de Edad , Anciano , Clima , Estado de Salud , Humanos , Matrimonio , Medicaid , Medicare , Estadística como Asunto , Estados UnidosRESUMEN
Nursing home reimbursement systems which do not adjust payment levels to patient care needs lead to access problems for heavy-care patients. Unnecessarily long and costly hospital stays may result. A patient-based nursing home incentive reimbursement system has been designed and is being evaluated in a controlled field experiment in 36 California skilled nursing facilities. Incentives are paid for admitting heavy-care patients, meeting outcome goals on some patients, and discharging and maintaining some patients in the community. This article describes a nursing home reimbursement system which is intended to simultaneously mitigate problems of restricted access, inefficient use of beds, and nonoptimal care. It also discusses the approach to evaluating this broad social intervention by application of a controlled experimental design.
Asunto(s)
Costos y Análisis de Costo , Grupos Diagnósticos Relacionados , Casas de Salud/economía , Mecanismo de Reembolso , Reembolso de Incentivo , California , Enfermedad Crónica , Humanos , Medicaid , Proyectos Piloto , Análisis y Desempeño de TareasRESUMEN
Nursing homes represent the fastest growing component of health care expenditures, over half of which come from public funds. This paper reviews research on nursing home utilization with regard to several policy issues concerning the subsidization of long-term care by Medicaid. As a background, the paper defines and contrasts three concepts; need, demand, and utilization. It then indicates how Medicaid policies regarding reimbursement of homes and eligibility for support can result in a chronic shortage of beds and describes the estimated effects on utilization of eight variables: Medicaid generosity, age structure, family resources, racial composition, residence, financial capability of the elderly, price of nursing home care and alternative sources of care. The paper concludes that there is a need for: subsidization of a more comprehensive set of long-term care services, a review of reimbursement policies, and improved methods of allocating existing nursing home beds among persons desiring care.