ABSTRACT
As the need for long-term care of people with disabilities increases, the model of care faces crucial changes, including a shift from institutional to independent living, significant changeover in organizational auspices, and policies created by the Americans with Disabilities Act. Such systemic changes pose fiscal, technological, and social challenges to policymakers and managers of care delivery.
Subject(s)
Health Policy , Long-Term Care , Disabled Persons/legislation & jurisprudence , Health Expenditures , Health Services Research , Insurance, Health , Organizational Innovation , Private Sector , Public Sector , United StatesSubject(s)
Health Services for the Aged/economics , Medicaid/economics , Medicare/economics , Patient Selection , Aged , Centers for Medicare and Medicaid Services, U.S. , Cost-Benefit Analysis , Eligibility Determination , Humans , Long-Term Care/economics , Reimbursement Mechanisms/economics , United StatesABSTRACT
In this article, we present population estimates of individuals with disabilities and discuss the manner in which the composition of this population is changing. We then highlight aspects of service delivery systems that are evolving in response to the changing long-term care (LTC) population. Following a summary of financing issues, we discuss several cross-cutting issues related to the organization of service delivery, quality assurance (QA), and financing. Current and future Health Care Financing Administration (HCFA) research and demonstrations emerging from these issues are then described.
Subject(s)
Disabled Persons/statistics & numerical data , Health Services Needs and Demand/trends , Long-Term Care/trends , Chronic Disease/economics , Chronic Disease/therapy , Comprehensive Health Care/organization & administration , Demography , Financing, Government , Forecasting , Health Expenditures/trends , Health Services Research/organization & administration , Humans , Insurance, Long-Term Care , Long-Term Care/economics , Long-Term Care/standards , Medicaid/statistics & numerical data , Medicare/statistics & numerical data , Pilot Projects , United StatesABSTRACT
Two broadly applied systems in the United States, the National Resident Assessment Instrument/Minimum Data Set and the Resource Utilization Groups, have provided new insight into the quality, delivery, and financing of nursing home care. In this article, the authors describe research efforts in eight other nations to translate, validate, and use one or both systems to understand their own long-term care systems. This consortium of studies, using common instruments, provides potential cross-national analyses that capitalize on differences in practice patterns and system designs to address critical policy issues.
Subject(s)
Diagnosis-Related Groups/classification , Health Resources/statistics & numerical data , Long-Term Care/classification , Nursing Homes/statistics & numerical data , Activities of Daily Living/classification , Aged , Aged, 80 and over , Asia , Australia , Centers for Medicare and Medicaid Services, U.S. , Data Collection/standards , Diagnosis-Related Groups/statistics & numerical data , Europe , Forms and Records Control/methods , Frail Elderly/statistics & numerical data , Geriatric Assessment/classification , Homes for the Aged/classification , Homes for the Aged/statistics & numerical data , Humans , Inpatients/classification , Nursing Homes/classification , United StatesABSTRACT
Trends in Medicaid payments and utilization from 1975 through 1989 are examined in this article. Medicaid payments grew significantly over the period 1975-89, but the rate of growth was uneven. Total payments grew rapidly from 1975 through 1981, but the rate of growth slowed considerably from 1982 through 1988. Recent data suggests that there may be a new discontinuity in the series; payments increased sharply in 1989. Sectors that account for growth in the costs of the program are identified by examining who are served and what types of services they receive. The dynamics of change in Medicaid payments within sectors also are explored by examining changes in the number of people receiving services and the average payment per recipient.
Subject(s)
Health Expenditures/statistics & numerical data , Insurance, Health, Reimbursement/statistics & numerical data , Medicaid/statistics & numerical data , Adult , Aged , Child , Child, Preschool , Data Collection , Eligibility Determination/economics , Humans , Income , Medicaid/trends , Poverty , United StatesSubject(s)
Health Benefit Plans, Employee/organization & administration , Military Medicine/economics , Contract Services , Cost Control , Health Services Accessibility , Insurance Pools , Military Medicine/organization & administration , Organizational Innovation , Preferred Provider Organizations , Primary Health Care , Referral and Consultation , United StatesABSTRACT
Nursing home care has become a major governmental responsibility. Public expenditures for nursing home care amounted to $7.3 billion in 1977. They represented 57.2 percent of the $12.8 billion nursing home bill nationally and 12 percent of public spending on all personal health care. Nursing home care absorbs more than one-third of all Medicaid expenditures. This paper explores expenditure patterns in recent years and discusses some of the factors that will influence these patterns in the future. First we analyze recent trends over the five-year period ending 1977. Then we project future utilization based on current age-specific use rates. Finally, we review recent studies on the potential cost of savings of noninstitutional alternatives to nursing home care.
