Pawlson L G, Lavizzo Mourey R J
Department of Health Care Sciences, George Washington University Medical Center, Washington, DC 20037.
J Am Geriatr Soc. 1990 Jun;38(6):696-703. doi: 10.1111/j.1532-5415.1990.tb01431.x.
A joint public-private insurance program is the best approach to resolving the problem of financing long-term care. In this report, we describe one possible approach in detail. A modest expansion of the current (ie, after repeal of the Medicare Catastrophic Coverage Law of 1988) Medicare benefit for persons needing relatively short-term nursing home and home care services would be a first step. For those with extended long-term service needs, a non-means tested, publicly funded program with joint federal-state financing and administration would provide coverage after a substantial elimination period and with an income-related copayment. Private long-term care insurance purchased through employers before retirement or in the periretirement period, through use of income or equity accumulated in life insurance, pension funds, or home ownership, would be used to fund the exclusionary period or copayments of the public program by those who wish to have greater protection for income or assets. The role of Medicaid would be limited to paying for the deductible, copayments, and initial long-stay expenses of those with low incomes and limited assets.
公私合营的保险计划是解决长期护理融资问题的最佳途径。在本报告中，我们详细描述了一种可能的方法。第一步是适度扩大现行（即1988年《医疗保险灾难性保险法》废除后）针对需要相对短期疗养院和家庭护理服务的人群的医疗保险福利。对于有长期服务需求的人，一个非经济状况调查的、由联邦和州联合资助和管理的公共项目将在经过一段较长的免责期后提供保险，并根据收入收取共付费用。在退休前或临近退休时通过雇主购买的私人长期护理保险，通过使用人寿保险、养老基金或自有住房积累的收入或资产，将被用于为那些希望对收入或资产获得更大保护的人支付公共项目的免责期费用或共付费用。医疗补助计划的作用将限于为低收入和资产有限者支付免赔额、共付费用和初期长期住院费用。
