长期护理筹资的基本策略。

Hospital progress Pub Date : 1984-02-01
J A Greenberg, W N Leutz
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引用次数: 0

摘要

由于控制医疗补助长期护理支出的压力越来越大,短期的“权宜之计”必须避免。其中有三种错误的解决方案存在缺陷,实际上可能会加剧长期护理的财务困境,因为它们是基于对问题的不充分定义。其中两项提案——立法扩大家庭对接受医疗补助的制度化老年人的责任,扩大国家对这些老年人不动产的留置权——错误地试图强制要求“照顾”,并且基于对“支出下降”问题的误解。另一项提议是为照顾老人的家庭成员提供税收优惠,这需要一个庞大的行政机构,假设供应有弹性,但这种弹性可能并不存在,而且可能会破坏家庭交流通常基于的“礼物关系”。我们所需要的是一个具有短期、中期和长期目标的战略,并朝着保险的方向发展。短期计划应该为中期战略奠定基础,并通过改变费率确定方法和限制设施建设来控制费用。中间计划应该将问题的定义从仅仅控制医疗补助长期护理支出转变为通过发展针对最需要的老年人的国家融资和地方交付系统,有效地管理老年人的国家资源。实现这一目标的一个有效手段是建立社会/卫生保健组织,它有五个主要特点:服务责任和权威的整合;组织设计的灵活性;平衡客户;汇集预付资金;以及医疗机构的财务风险。最后,长期战略应该将大部分长期护理的财政负担从个人和州医疗补助机构转移到保险机制。因此,许多人将避免因医疗保健支出而导致的贫困,而医疗补助计划将大大减少其病例量。此外,保险是一种适当的筹资机制,因为相对较少的人会承担高昂的费用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A basic strategy for financing long term care.

As pressure mounts to contain Medicaid long term care spending, short-range "quick fixes" must be avoided. Three such false solutions in particular have shortcomings that may actually exacerbate long term care's financial dilemma because they are based on inadequate definitions of the problem. Two of these proposals--legislation to broaden family responsibility toward institutionalized elders on Medicaid and expanded state power to put liens on such elders' real property--err by trying to mandate "caring" and are predicated on a misunderstanding of the "spend-down" problem. The other proposal--to provide tax incentives to family members who care for elders--requires a large administrative apparatus, assumes an elasticity of supply that may not exist, and could disrupt the "gift relationship" on which family exchanges are often based. What is needed is a strategy with short term, intermediate, and long term objectives that move toward an insurance approach. The short term plan should lay the groundwork for intermediate strategy and control costs by changing rate-setting methods and putting limits on facility construction. The intermediate plan should change the problem's definition from one of merely controlling Medicaid long term care expenditures to one of efficiently managing state resources for the elderly through the development of state financing and local delivery systems that target older persons in greatest need. An effective means of doing this is through the creation of social/HMOs, which have five key features: integration of service responsibility and authority; flexibility in organizational design; balanced clientele; pooled prepaid funding; and financial risk for the provider organization. Finally, the long term strategy should transfer much of the long term care financial burden from individuals and state Medicaid agencies to insurance mechanisms. Many individuals would thus avoid impoverishment caused by health care spending and Medicaid would greatly reduce its caseload. Insurance coverage is an appropriate funding mechanism, moreover, in that relatively few persons will ever incur high costs.

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