Langa K M, Chernew M E, Kabeto M U, Katz S J
Department of Medicine, University of Michigan, Ann Arbor 48109-0429, USA.
Med Care. 2001 Feb;39(2):147-57. doi: 10.1097/00005650-200102000-00005.
Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services.
The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members.
Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05).
The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children.
20世纪90年代，家庭医疗保健的公共支出迅速增长，但新增服务的目标人群仍不明确。本研究旨在检验快速增长的支出是否针对残疾程度高且社会支持水平低的老年人，这两类人群历来使用付费家庭医疗和养老院服务的比例较高。
资产与健康动态研究是一项对70岁及以上人群（n = 7443）进行的具有全国代表性的纵向调查，用于确定1993年和1995年残疾程度和社会支持水平与付费家庭护理服务使用之间的关联。使用多变量回归模型对社会人口统计学、近期住院或入住养老院情况、慢性疾病状况以及接受家庭成员的非正式护理等因素进行调整。
在1993年和1995年，残疾程度较高的人群每周获得的付费家庭护理调整时长更多。1993年，社会支持最少（未婚独居）的付费家庭护理使用者每周获得的调整护理时长比与他人同住的未婚老年人（24小时对13小时，P < 0.01）和已婚老年人（24小时对18小时，P = 0.06）更多。然而，到1995年，与他人同住的未婚者接受的付费家庭护理最多：未婚独居者为40小时，而未婚独居者为26小时（P < 0.05），已婚者为24小时（P < 0.05）。
近期正规家庭护理服务的大幅增加，不成比例地流向了社会支持较多的人群。20世纪90年代初的家庭护理政策变化导致家庭护理服务的分配转向与子女同住的老年人。
