Grabowski David C
Harvard Medical School, USA.
Med Care Res Rev. 2006 Feb;63(1):3-28. doi: 10.1177/1077558705283120.
There has been significant expansion and change in the financing, coverage, and delivery of home- and community-based services during the past decade. This article reviews the cost-effectiveness of Medicaid waiver programs, consumer-directed care, capitated models that blend acute and long-term care services, and case management and subsidized community services for individuals with dementia. Generally, these new care models werefound to be associated with increased costs, but greater client and caregiver welfare. Depending on the specific features of the program, capitated care models and consumer-directed care were identified as potential mechanisms toward providing services more efficiently. Importantly, however, most recent evaluations have relied on potentially confounded research designs, which leaves open the question of whether the findings relate to the programs or biased selection across the treatment and comparison groups.
在过去十年中，家庭和社区服务的融资、覆盖范围及提供方式都有了显著的扩展和变化。本文回顾了医疗补助豁免计划、消费者导向型护理、融合急性和长期护理服务的按人头付费模式，以及针对痴呆症患者的病例管理和补贴社区服务的成本效益。总体而言，这些新的护理模式被发现与成本增加相关，但能为客户和护理人员带来更大福祉。根据项目的具体特征，按人头付费护理模式和消费者导向型护理被确定为更高效提供服务的潜在机制。然而，重要的是，最近的评估大多依赖于可能存在混淆的研究设计，这使得研究结果是与项目本身相关，还是因治疗组和对照组之间的选择偏差所致这一问题悬而未决。
