Stockton P, Rabin D L
J Med Pract Manage. 1987 Spring;2(4):225-33.
Home care has been promoted as an alternative to acute and long-term care in hospitals and nursing homes in the interests of controlling the high and rising costs of institutional care. This has resulted in legislative and regulatory changes to public programs, of which the elderly are the main beneficiaries. Consequently, there has been major growth and change in the home care industry with Medicare being the largest third-party payor and primary income source for many home care agencies. The industry is now coming under closer scrutiny as a result of the increasing public expenditures, and concerns regarding public accountability and the cost-effectiveness of care delivered by this fragmented and relatively unregulated sector have been expressed. There is now increasing evidence that industry expectations of future growth may not be met from publicly funded home care programs for the elderly as currently conceived, regulated, and reimbursed. Changes are likely to result in an expanded role for the physician in home health care planning and supervision.
为了控制机构护理高昂且不断上涨的成本，居家护理已被推广为医院和养老院急性护理及长期护理的替代方案。这导致了公共项目的立法和监管变化，老年人是主要受益者。因此，居家护理行业出现了重大增长和变革，医疗保险成为许多居家护理机构最大的第三方付款人和主要收入来源。由于公共支出不断增加，该行业目前正受到更密切的审查，人们对这个分散且相对不受监管的部门所提供护理的公共问责制和成本效益表示担忧。现在越来越多的证据表明，按照目前的构想、监管和报销方式，由公共资金资助的老年人居家护理项目可能无法满足该行业对未来增长的期望。这些变化可能会使医生在家庭医疗保健规划和监督中发挥更大的作用。
