Binney E A, Estes C L, Ingman S R
Department of Social and Behavioral Sciences, University of California, San Francisco 94143.
Soc Sci Med. 1990;30(7):761-71. doi: 10.1016/0277-9536(90)90199-3.
This paper examines the medicalization of community-based services for the elderly; a process of restructuring to provide more highly medical services to a frail older population at the expense of providing a broader range of social and supportive services to older persons with varying levels of need. Medicalization is tied to changes in government policy (particularly Medicare reimbursement) which have led to increased competition within the health and social service sector. The paper utilizes data on services, policy impact and staffing from the DRG Impact Study conducted at the Institute for Health and Aging (UCSF), a 3-year study of the impacts of federal policy on 7 types of community providers of services to the elderly. Data are presented from telephone interviews conducted at two points in time (1986 and 1987) with directors of a representative sample of home health agencies (HHAs). Findings include: HHAs were more likely to report adding highly medical services and cited social/supportive services (as opposed to highly medical and/or highly technical services) as the most commonly requested services they cannot provide. Policy effects and societal implications of the medicalization of home care are considered.
本文探讨了针对老年人的社区服务医学化问题；这是一个重组过程，旨在为体弱的老年人群体提供更高水平的医疗服务，却牺牲了为不同需求程度的老年人提供更广泛的社会和支持性服务。医学化与政府政策的变化（尤其是医疗保险报销政策）相关联，这些变化导致了健康和社会服务部门内部竞争加剧。本文利用了健康与老龄化研究所（加州大学旧金山分校）开展的疾病诊断相关分组（DRG）影响研究中的服务、政策影响和人员配备数据，该研究历时3年，考察了联邦政策对7类老年人社区服务提供者的影响。数据来自于在两个时间点（1986年和1987年）对具有代表性的家庭健康机构（HHA）样本的主任进行的电话访谈。研究结果包括：家庭健康机构更有可能报告增加了高度医疗服务，并指出社会/支持性服务（与高度医疗和/或高技术服务相对）是他们最常无法提供的被需求服务。文中还考虑了家庭护理医学化的政策影响和社会影响。
