MacAdam M, Greenberg J, Greenlick M, Gruenberg L, Malone J
Bigel Institute for Health Policy, Brandeis University, Waltham, MA.
J Appl Gerontol. 1991 Dec;10(4):389-405. doi: 10.1177/073346489101000402.
This study examined the effect of differing eligibility rules for receipt of long-term care services in the four sites of the Social/HMO National Demonstration Program. Data from the first year of Social/HMO enrollment were used to model the probability of receiving a comprehensive assessment of need for long-term care benefits. Sites using state criteria for Medicaid reimbursement of a nursing home stay were more likely to give assessments to elders with functional impairment problems, whereas those using broader eligibility criteria gave assessments to enrollees with a wider range of characteristics. The results indicate that decisions about eligibility for care have important access and cost implications for consumers, payers, and providers.
本研究考察了社会/健康维护组织全国示范项目四个地点长期护理服务不同资格规则的影响。利用社会/健康维护组织注册第一年的数据，对接受长期护理福利需求综合评估的概率进行建模。采用州医疗补助报销疗养院住院标准的地点，更有可能对有功能障碍问题的老年人进行评估，而采用更广泛资格标准的地点，则会对更多具有不同特征的参保人进行评估。结果表明，护理资格的判定对消费者、付款人和提供者在获取服务及成本方面具有重要影响。
