Search

This research compares the quality of life of Malaysian elderlies living in public formal long-term care institutions, including residential care and nursing home care. It provides evidence of the cost-effectiveness of both programs. The sample of Malaysian elderlies aged 60 years and above was collected from the World Health Survey, including five dimensions of health status: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. Each of the dimensions has three levels, including 1 ("no problems"), 2 ("some problems") and 3 ("major problem"). The quality-adjusted life-years (QALYs) of elderlies living in both institutions are estimated using a generic health-related measurement method, EQ-5D. In addition, cost-utility analysis is adopted to compare the effectiveness of programs in allocating resources. The QALY of those living in nursing home care is reasonably lower than those in residential care due to their worse chronic health conditions. The majority are categorised as severely disabled. The cost-effectiveness evaluation of each public long-term care model suggests that the residential care program is cost-effective, with the cost per QALY being MYR22 945. At the same time, a nursing home for disabled people is not effective as the cost per QALY is MYR57 822, falls outside the willingness to pay (WTP) range between (MYR 19,929--MYR 28,470). [ABSTRACT FROM AUTHOR]

Objectives Hospitalization in community-dwelling elderly is often accompanied by functional loss, increasing the risk for continued functional decline and future institutionalization. The primary objective of our study was to examine the hospital-level variation in rates of new institutionalizations among Medicare beneficiaries. Design Retrospective cohort study. Setting Hospitals and nursing homes. Participants Medicare fee-for-service beneficiaries discharged from 4,469 hospitals in 2013 (N = 4,824,040). Measurements New institutionalization, defined as new long term care nursing home residence (not skilled nursing facility) of at least 90 days duration within 6 months of hospital discharge. Results The overall observed rate of new institutionalizations was 3.6% (N = 173,998). Older age, white race, Medicaid eligibility, longer hospitalization, and having a skilled nursing facility stay over the 6 months before hospitalization were associated with higher adjusted odds. Observed rates ranged from 0.9% to 5.9% across states. The variation in rates attributable to the hospital after adjusting for case-mix and state was 5.1%. Odds were higher for patients treated in smaller ( OR = 1.36, 95% CI: 1.27-1.45, ≤50 vs >500 beds), government owned ( OR = 1.15, 95% CI: 1.09-1.21 compared to for-profit), limited medical school affiliation ( OR = 1.13, 95% CI: 1.07-1.19 compared to major) hospitals and lower for patients treated in urban hospitals ( OR = 0.79, 95% CI: 0.76-0.82 compared to rural). Higher Summary Star ratings ( OR = 0.75, 95% CI: 0.67-0.93, five vs one stars) and Overall Hospital Rating ( OR = 0.62, 95% CI: 0.57-0.67, ratings of 9-10 vs 0) were associated with lower odds of institutionalization. Conclusion Hospitalization may be a critical period for preventing future institutionalization among elderly patients. The variation in rates across hospitals and its association with hospital quality ratings suggest some of these institutionalizations are avoidable and may represent targets for care improvement. [ABSTRACT FROM AUTHOR]

Objectives To determine the effect and cost-effectiveness of training nonnursing staff to provide feeding assistance for nutritionally at-risk nursing home ( NH) residents. Design Randomized, controlled trial. Setting Five community NHs. Participants Long-stay NH residents with an order for caloric supplementation (N = 122). Intervention Research staff provided an 8-hour training curriculum to nonnursing staff. Trained staff were assigned to between-meal supplement or snack delivery for the intervention group; the control group received usual care. Measurements Research staff used standardized observations and weighed-intake methods to measure frequency of between-meal delivery, staff assistance time, and resident caloric intake. Results Fifty staff (mean 10 per site) completed training. The intervention had a significant effect on between-meal caloric intake ( F = 56.29, P < .001), with the intervention group consuming, on average, 163.33 (95% CI = 120.19-206.47) calories per person per day more than the usual care control group. The intervention costs were $1.27 per person per day higher than usual care ( P < .001). The incremental cost-effectiveness ratio for the intervention was 134 kcal per dollar. The increase in cost was due to the higher frequency and number of snack items given per person per day and the associated staff time to provide assistance. Conclusion It is cost effective to train nonnursing staff to provide caloric supplementation, and this practice has a positive effect on residents' between-meal intake. [ABSTRACT FROM AUTHOR]

Over the past 10 years, merger activities in the private for-profit nursing home industry have been increasing in Europe. In this paper, we investigate chain affiliation’s influence on the performance of lucrative nursing homes. We measure performance using a cost frontier estimated by stochastic analysis on a sample of 370 French for-profit nursing homes. We find that cost efficiency decreases with the number of facilities in a chain. We also identify different external actor types in nursing homes’ institutional environment and test their influence. We show that nursing home chains’ cost efficiency improves when local governments and shareholders exert pressure. Our results are robust to alternative model specifications and another definition of costs. Overall, our findings inform researchers, as well as standards setters, of the relevance of chain affiliation and of the role of institutional pressures regarding cost containment at the nursing home level. [ABSTRACT FROM PUBLISHER]

Widespread issues regarding quality in nursing homes call for an improved understanding of the relationship with costs. This relationship may differ in European countries, where care is mainly delivered by nonprofit providers. In accordance with the economic theory of production, we estimate a total cost function for nursing home services using data from 45 nursing homes in Switzerland between 2006 and 2010. Quality is measured by means of clinical indicators regarding process and outcome derived from the minimum data set. We consider both composite and single quality indicators. Contrary to most previous studies, we use panel data and control for omitted variables bias. This allows us to capture features specific to nursing homes that may explain differences in structural quality or cost levels. Additional analysis is provided to address simultaneity bias using an instrumental variable approach. We find evidence that poor levels of quality regarding outcome, as measured by the prevalence of severe pain and weight loss, lead to higher costs. This may have important implications for the design of payment schemes for nursing homes. [ABSTRACT FROM AUTHOR]

Nearly 8,000 people reside in Rhode Island's (RI's) 84 nursing homes at any single point in time. Many of these people are highly vulnerable because of illness or frailty. In this article, we describe the reasons that RI residents seek care from nursing homes, the associated costs (with a focus on medicare and medicaid payment), and different ways to assess nursing home quality. We also describe the home- and community-based services that can help people remain in the community. A resource list provides additional information for those seeking to better understand RI nursing homes and long-term care supports and services. [ABSTRACT FROM AUTHOR]

The article discusses research regarding the prevalence of nursing home specialists in American between 2012 and 2015, and it mentions a strategy for improving medical care which involves the employment of medical professionals who specialize in treating hospitalized patients. Nursing home care costs and quality are addressed, along with U.S. Medicare health insurance fee-for-service billing and the claim that 21 percent of the nursing home clinicians in 2015 were nursing home specialists.

The author offers insights the possible reform of nursing homes in the U.S. Topics discussed include the care and assistance needed by nursing home residents, the cost of home- and community-based services for the elderly compared to the cost of living in nursing care facilities, and the need to increase the earnings of the caregiving workforce.

Long term care in Germany is provided in nursing homes, by professional ambulatory services and by the patient's relatives at home, with the latter being predominantly provided by women. Given an increasing labour market participation of women, long term care at home by female relatives might become less frequent in the future which in turn may result in rising demand for and hence rising prices for long term care services. This paper builds upon the existing literature on the determinants of nursing home prices and investigates whether the labour market participation and the education level of women are correlated with the prices of nursing homes. To the best of our knowledge, this is the first study using panel data approaches in this field of research. Based on a full sample of nursing homes in Germany for the years 2001, 2003, 2005 and 2007, our empirical results suggest that a high share of full-time employed women aged 50-65 at the district level is not associated with higher prices of nursing homes. Furthermore, we find only weak evidence for a positive correlation of prices with the local average of women's educational level and a negative correlation with part-time employment indicating that price levels are lower in regions with higher shares of part-time employed women. [ABSTRACT FROM AUTHOR]

Objective. Approximately 8% of nursing home patients in Sweden have a long-term indwelling catheter. A catheter requires daily care and regular changes (basic care). Beyond this, significant numbers of patients are troubled by frequent complications necessitating acute catheter changes and/or rinses. The aim of this study was to calculate the costs associated with long-term indwelling catheters among patients at nursing homes. Material and methods. All 366 patients with indwelling urinary catheters at 78 nursing homes were followed prospectively for 1 year and all catheter-related procedures, rinses, and changes were registered and the costs of the procedures calculated. Results. The basic cost was calculated to be SEK 1157 per month and patient. The average monthly cost for acute interventions was estimated to range from SEK 169 in the quartile with few such events up to SEK 455 in the quartile with frequent acute interventions. Personnel accounted for over 90% of the costs associated with indwelling catheters. Conclusions. Basic catheter care was more cost intensive than acute interventions. This applied even for the 25% of subjects frequently troubled by complications requiring acute catheter changes or rinses. The cost of the catheters and material used in connection with catheter rinses/irrigations was low compared with the cost of the personnel undertaking the procedures. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Social Intervention: Theory & Practice is the property of Universiteit Utrecht and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Advisors need to alter the perspective that many clients may be able to"self-insure" if they have accumulated some magical dollar amount of assets. The focus should shift to income requirements, not assets, to meet long-term care costs. If a portfolio is designed to generate a retirement income goal without regard to a potential extended care event requiring additional income, it will fail to perform successfully. [ABSTRACT FROM AUTHOR]

Despite widespread interest in the medical home model, there has been a lack of careful assessment of alternative methods to pay practices that serve as medical homes. This paper examines four specific payment approaches: enhanced fee-for-service payments for evaluation and management; additional codes for medical home activities within fee-for-service payments; per patient per month medical home payments to augment fee-for-service visit payments; and risk-adjusted, comprehensive per patient per month payments. Payment policies selected will affect both the adoption of the model and its longer-term evaluation. Evaluations of ongoing demonstrations should focus on payment design as well as on care-and cost. [ABSTRACT FROM AUTHOR]

AbstractPsychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available. [ABSTRACT FROM AUTHOR]

This analysis extends earlier work using national data to examine Medicaid nursing facility (NF) utilization (participants per aged population) and its interrelationships with Medicaid per diem NF reimbursement rates and NF bed capacity, using state-level data over 19 years to estimate two-stage structural equations. Findings demonstrate complex relationships among these factors. Reimbursement rates showed no demonstrable impact on utilization but positive effects on beds. Beds, in turn, positively predict utilization and negatively predict rates. Findings suggest that policy makers might focus on constraining Medicaid NF costs through controlling bed stock rather than by keeping rates lower, which can have untoward effects on quality and equity. [ABSTRACT FROM AUTHOR]

The article examines the background of the challenges around home and residential care charging in Great Britain. Base from several surveys, the authors found that local authorities are providing care only to those people who are critically in need, while many older people are forced to rely on informal care at home because they cannot afford their local authority charges. The authors suggest the need to reform the social care system in a way that older people can choose the kinds of services that they want in affordable price.

Purpose: There is debate about the relative merits and costs of private versus shared bedrooms in nursing homes, particularly in light of the current efforts at creating both cost-efficient and person-centered care facilities. The purpose of this project was to explore the extent to which there is evidence-based information that supports the merits of three different bedroom configurations: traditional shared, enhanced shared, and private. Design and Methods: We developed a framework of four broad domains that were related to the different bedroom configurations: psychosocial, clinical, operational, and construction or building factors. Within each dimension, we identified individual factors through the literature, interviews, and focus groups, with the goal of determining the breadth, depth, and quality of evidence supporting the benefits of one configuration over another. Results: The vast majority of factors identified in this study, regardless of whether there was solid empirical data, information from the focus groups, or other anecdotal evidence, indicated better outcomes associated with private rooms over shared rooms in nursing homes. Cost estimates suggest that construction cost (plus debt service) differences range from roughly $20,506 per bed for a traditional shared room to $36,515 for a private one, and that such differences are recouped in less than 2 years if beds are occupied, and in less than 3 months if a shared bed remains unoccupied at average private-pay room costs. Implications: Despite limited empirical evidence in some areas, this project provides the foundation for an evidence-based life-cycle costing perspective regarding the relative merits of different bedroom configurations. [ABSTRACT FROM AUTHOR]

Objective. To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Data Sources/Study Setting. Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design. Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods. Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings. Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions. Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents. [ABSTRACT FROM AUTHOR]

To examine nursing home expenditures on clinical, hotel, and administrative activities during the 1990s and to determine the association between nursing home competition and excess demand on expenditures. Secondary data sources for 1991, 1996, and 1999 for 500 free-standing nursing homes in New York State. A retrospective statistical analysis of nursing homes' expenditures. The dependent variables were clinical, hotel, and administrative costs in each year. Independent variables included outputs (inpatient and outpatient), wages, ownership, New York City location, and measures of competition and excess demand. Variables were constructed from annual financial reports submitted by the nursing homes, the Patient Review Instrument and Medicare enrollment data. Clinical and administrative costs have increased over the decade, while hotel expenditures have declined. Increased competition was associated with higher clinical and administrative costs while excess demand was associated with lower clinical and hotel expenditures. Nursing home expenditures are sensitive to competition and excess demand conditions. Policies that influence competition in nursing home markets are therefore likely to have an impact on expenditures as well. [ABSTRACT FROM AUTHOR]

To estimate the effect of state Medicaid nursing home reimbursement rates on hospitalizations of nursing home residents. Cross-sectional sample of nongovernment-owned nursing homes with 25 beds or more in one Metropolitan Statistical Area in each of 10 states in 1993, with 6 months follow-up on mortality and hospitalizations. Two hundred fifty-three nursing homes. Eight to 16 randomly selected residents from each facility, totaling 2,080. Minimum Data Set assessments conducted by research nurses at baseline. A three-category 6-month outcome was defined as (1) any hospitalization; for those not hospitalized, (2) death versus (3) alive in the facility. Using multinomial logistic regression, adjusted to survey design, controlling for resident and facility characteristics, a $10 increase in 1993 Medicaid reimbursement rate above the mean rate of approximately $75 resulted in a 9% reduction in a resident's risk of hospitalization ( P<.05). State Medicaid reimbursement rates appear to affect clinical decisions regarding the need for hospital admission and thresholds for nursing home use. The findings from this study reemphasize the importance of properly aligning state Medicaid and federal Medicare long-term care policies because, currently, states have no incentive to increase reimbursement rates to avoid hospitalization. [ABSTRACT FROM AUTHOR]

State Medicaid programs pay for a sizable portion of overall nursing home expenditures. The repeal of the Boren amendment in 1997 gave states greater freedom to set Medicaid nursing home policy. This study presents data from a comprehensive survey of state nursing home payment policies during 1999-2002. Aggregate inflation-adjusted Medicaid payment rates rose steadily, and there was no sizable increase in the adoption of other cost-cutting policies. Although these findings can be interpreted with some optimism from a nursing home financing perspective, areas of concern remain for state nursing home policy during the next several years. [ABSTRACT FROM AUTHOR]

Background Recent increases in care home closures suggest that homes may not be able to balance pressures to reduce costs against pressures to increase standards. Commissioning requires an understanding of the factors affecting costs and how they change over time. Methods A survey of care homes for older people was conducted in 21 local authorities in England in 1996. A complete response was obtained for 618 homes (75%) and 11,900 residents. Findings were compared with surveys conducted in 1986 and 1988. Results Dependency was significantly related to prices, primarily due to the differential payments to nursing and residential homes. Home characteristics were also related to price, the proportion of single rooms having the largest impact. However, prices were most sensitive to local wage rates, particularly in residential homes. Compared with previous surveys levels of dependency had increased, particularly in voluntary residential homes and nursing homes. Independent homes were more likely to be purpose built, and a higher proportion of beds were in single rooms, although only 30% of private residential, dual registered and nursing homes achieved the proposed level of 80% of beds in single rooms. Staffing ratios appeared to have increased, but price rises were modest, particularly for nursing homes. Conclusions Standards of provision have improved over time, although prices appear to have been kept below those expected from increases in costs. Continuing pressures on costs and prices are likely to lead to further closures and a restriction of choice for older people. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Part II. Examines the principles and practice behind bed purchasing in rehabilitation services for older people in Great Britain. Factors that must be considered when purchasing beds; Standards of care required; Range of medical services for older people who are living in homes; Dental services for older people; Recreational and leisure activities provided in the nursing homes.

Examines the Medicaid long-term care expenditures in the United States for federal fiscal year 2000. Increase in Medicaid spending for nursing home care; Total spending cost for institutional services in 2000; Tabular representation of the state-specific rates for Medicaid long-term care services.

Presents a study which examined whether ancillaries are included in the Medicaid nursing home reimbursement rates and how ancillaries influence the interstate comparison of such rates. Methods; Results; Discussion.

Medicaid nursing home reimbursement methods and per diem rates affect costs, quality, equity, and access. State rate-setting is a laboratory of policymaking, which can inform state and federal Medicaid reform initiatives. This paper explains state Medicaid nursing facility rates in 1979-1994. Findings suggest that prospective facility-specific methods constrained rates in some but not all periods, particularly when older cost-reports were employed in rate-setting. Analysis failed to show that prospective class rate-setting methods constrained rate increases. Findings suggest that the efficacy of reimbursement methodology to control rates depends upon wider health care policy trends and that future facility-level analyses should consider policy contexts as between states. [ABSTRACT FROM AUTHOR]

The objective of the study was to establish the arrangements for provision of general practitioner (GP), nursing advice, chiropody, physiotherapy and speech and language services to nursing homes and to establish the charging policies for those services. To this end a telephone survey of the managers of the 51 nursing homes registered with one English health authority, Merton, Sutton and Wandsworth Health Authority, was undertaken. Forty-nine homes (96%) with 1541 residents responded. Twenty per cent of homes had no regular GP visits and half the homes had no planned medication reviews. One in five homes (27% of residents) had access to all health-care services. Eight homes (10% of residents) did not have access to therapy services or nursing advice. Thirty-three homes used private or both private and NHS chiropody services and 16 homes used the NHS service only. Seventeen homes used private or both private and NHS physiotherapy services with 10 homes receiving a regular private service. Twenty homes used the NHS service and 12 homes (15% of residents) had used no physiotherapy service. None used private speech and language services. Twenty-four of the 33 homes using private chiropody charged extra for this service compared with two of 10 homes using regular private physiotherapy. The findings suggest that there are inequalities in access to health care services in nursing homes. Moreover, there has been a deterioration in access to and levels of provision of NHS nursing and physiotherapy services since the national survey undertaken by the Office Population Censuses and Surveys (OPCS) in Great Britain in the mid-1980s. The new regulatory framework for older people must include systems for monitoring the provision of health services. [ABSTRACT FROM AUTHOR]

A prospective study was carried out in Taiwan to measure the family cost of caregiving at home for 289 patients newly diagnosed with dementia (106 with senile-type dementia, 171 with vascular-type dementia). Their families were first interviewed in the outpatient department and then followed for 1 month after the dementia diagnosis was made. Simultaneously, the costs for providing nursing home care to patients with dementia were calculated using accounting data reported from six nursing homes. Comparisons were made between the amount and type of cost encountered by families and by nursing homes to determine whether family-based care was cheaper and more appropriate than nursing home care for dementia patients with different functional levels. The results showed that higher costs were encountered for caregiving at home when the patients had severe dependence. This tendency was more evident for patients with senile dementia than for patients with vascular-type dementia. The cost of labour was an important expense for families caring for patients at home (at least 85% of family costs). Our findings suggest that, when family labour cost is considered, nursing home care is less expensive than family-based care for long-term care, especially for dementia patients with severe or moderate dependence. Nursing home care is also a better choice when patients have great need for multiple health services. [ABSTRACT FROM AUTHOR]

This paper reports on a pilot project funded jointly by South and West Devon Health Authority and Devon Social Service department which sought to overcome some of the problems encountered with liaison between services, and to improve carer experience and access to social services. This involved the placement in a Plymouth general practitioner (GP) surgery of a social service care manager who worked from the surgery and was allocated extra hours for carer support work. The project was evaluated and compared with the current experience of carers in the more ‘traditional’ setting. The experience and attitude of GPs in two other surgeries were also explored. The traditional model of work seen in Surgery B and C, the comparison surgeries, was a crisis intervention model which was regarded as adequate by the GPs involved, who had no experience of any other way of working. They directed the carers to telephone or write to social services themselves, or in a few cases the GP contacted social services on their behalf. However, the data showed that carers were less satisfied with this traditional model and preferred the more ‘instant’ access to support, made possible through the pilot worker in Surgery A. In the pilot project a short and informal visit to the pilot worker on request was seen as a relief by the carers. They had avoided the gate-keeping and bureaucracy involved in the ‘normal’ process. The drawing together of the various strands of the research showed conclusively that the pilot project in Surgery A was successful in meeting the majority of objectives set out for it. It has been a success in the perception of the carers and all of the professionals and staff involved. Staff involved all agreed that cross service collaboration between social services and the GP surgery had been improved, and that this had improved the service available to patients and carers. [ABSTRACT FROM AUTHOR]

The article discusses failures within the health care market in Germany. The author contends that a so-called "cost explosion" has led to increasing premium rates that are a cost burden for employers and organizations. Reasons for the drastic cost increases include a rise in the number of elderly citizens, the development of new pharmaceuticals and medical technology, and capacity issues in hospitals.

Background. In a recent randomized controlled trial assessing the efficacy of an inpatient geriatric assessment unit (GAU), we demonstrated that patients assigned to the unit were less likely than those in the usual care group to be admitted to a nursing home and more likely to remain living in the community. Despite evidence of benefits of GAU care, questions remain about its cost. We examine the impact of GAU treatment on subsequent health care charges. Methods. Sequential referrals of elderly disabled patients considered at risk for institutionalization or likely to improve with rehabilitation were randomized to the GAU or to usual care. Charge data were collected on utilization of a wide variety of health care services starting at the point of randomization. Results. The group randomized to the GAU experienced significantly higher rehabilitation charges per participant ($10,583 vs $2066, P = .0001), but lower mean nursing home charges ($1798 vs $3426, P = .004). Total health care charges per participant over the 1 year follow-up were greater for the GAU group ($28,406 vs $16,444, P = .004). When charges were adjusted per year of life survived, the GAU group still showed a substantial (but nonsignificant, P = .10) increase in total charges. However, when charges were adjusted per day subsequently spent residing in the community, adjusted total charges were similar between the two groups. Conclusions. Our results indicated that improved outcomes from GAU care require an investment in rehabilitation that is not totally offset by decreased institutional charges in the following year. [ABSTRACT FROM AUTHOR]

The article focuses on cost of care in nursing homes. Number of factors are leading to increased interest in the nursing home industry. For one, the population is aging, and increased life expectancy will increase the need for long-term care services. In 1980, 11.3% of the population was age 65 and over, with 8.8% of that population age 85 and over. In 1994 12.7% of the population was 65 and over, while 10.6% were 85 and over. Expenditures for nursing homes reached $72.3 billion in 1994 accounting for 8 7% of all personal health money spent. INSET: Executive Summary.

The present arrangements for providing financial support for people in residential care and nursing homes unable to pay their own fees have evolved in a piecemeal way with little attempt to consider whether the charges the public purse is asked to make are reasonable. The article argues that reasonable is a relative not an absolute concept which, from the viewpoint of those with responsibility for public funds in this area, will be determined by the weight given to different policy objectives. This will become increasingly important once local authorities implement recent legislation which makes them responsible for administering a 'unified' community care budget. [ABSTRACT FROM AUTHOR]

This paper is concerned with the effect of prospective payment on Medicaid payment rates for nursing home care. The question is whether prospective payment systems lower costs. A multivariate model analyzes the effect of prospective payment system while controlling for other factors affecting costs. The data is a pooled cross section and times series of 47 states over twelve years. In contrast to previous research, our statistical model treats the state government's choice of payment system as endogenous. While prospective payment may lower costs in a given state, higher cost states also have more incentive to adopt perceived cost saving measures such as prospective payment. As high costs may drive a state to adopt prospective payment, costs and payment method may be simultaneously determined. We use an instrumental variable estimator to avoid any possible simultaneity bias. The statistical results of this paper suggest that prospective payment systems lower Medicaid costs for skilled nursing homes. The statistical model controlled for other variables governing state skilled care costs. These variables included cost of living differences, factor costs, the extent of federal medical subsidy to the state, state ability to pay for services, and the state political culture. In contrast to previous work, the prospective payment dummy variable was treated as endogenous. A priori reasoning and previous empirical studies suggest the likely endogeneity of prospective payment choice. [ABSTRACT FROM AUTHOR]

Certificate-of-need laws and construction moratoria are policies designed to control government expenditures by limiting the number of nursing home beds in an area. These policies also represent barriers to entry and can result in excess demand. This study investigates the effect of market concentration and excess demand on private prices for nursing home care. We find evidence that both factors are associated with higher prices. Because higher prices may cause private patients to exhaust their financial resources and become Medicaid patients sooner than they otherwise would, these policies may have had indirect cost-increasing consequences. [ABSTRACT FROM AUTHOR]

Compares the relative merits of attendant services provided by independent agencies with those of federally certified and state-licensed operations. Definition of `consumer direction'; Survey of statistical censuses of attendant services in various states; Impact of state regulatory and payment policies on client choice; Measures of consumer satisfaction correlated with greater freedom of choice; Tax aspects.

Despite the usual focus on daily costs, because PWAs have higher costs per day than other SNF residents, LOS and days of care are important cost indices. Data on LOS for 102 admissions and annual days of care for 90 PWAs show average 64-day LOS and 67 days of care. Regression analysis and survival analysis show dementias and IV drug use to mean longer LOS and more days of care. Higher PWA costs must be sustained over longer periods for PWAs with dementias and for IV drug users, who may claim increasing shares of the SNF care provided to PWAs. [ABSTRACT FROM AUTHOR]

The article presents a list of abstracts for health care marketing articles, including one about revising the health care system and another about nursing home costs.

Focuses on the effect of using case-mix payment systems in nursing homes. Criteria used for comparing the systems' efficiency; Resource utilization groups version II as the best nursing home payment system; Efficiency of the management minutes and the Minnesota case-mix system; Sensitivity of case-mix groups to cost differences.

The article presents a study on in-patient cost variability among mental subnormality hospitals. The study has noted that in the case of subnormality hospitals its has been conceivable that the input level of resources will be reflected by some significant measure of output, and the level of a hospital's budget is most likely to be reflected in the quality of life of the patients contained within it. It has concluded that a means must be found for assessing the impact of grossly dissimilar levels of expenditure have on the hospital population.