Ricker-Smith K, Trager B
Med Care. 1978 Mar;16(3):173-90. doi: 10.1097/00005650-197803000-00001.
Spiralling Medicare and Medicaid expenditures, recent revelations about unhealthy conditions in nursing homes, and pressure for national health insurance have led to increased interest in in-home health services as appropriate and cost-effective. Medicare and Medicaid provided some stimulus for development of in-home health services. Shortly after these programs went into effect, however, major policy decisions were made aimed at curbing utilization of in-home health services. California home health data for 1966-1973 document the effects of major policies that led to the development and decline of in-home health services under Medicare and Medicaid. A review of those policies, supported by the California data, indicate that in-home health services have been greatly restricted by historical underdevelopment and legislative and regulatory emphases. In addition, the study indicates the limitations of the kind of data currently collected and suggests data requirements necessary for future program evaluation and planning in home health.
医疗保险和医疗补助支出不断攀升，近期有关养老院不健康状况的披露，以及全民医疗保险面临的压力，引发了人们对居家健康服务的浓厚兴趣，认为其既合适又具有成本效益。医疗保险和医疗补助为居家健康服务的发展提供了一些刺激。然而，在这些项目生效后不久，就做出了旨在遏制居家健康服务使用的重大政策决策。1966年至1973年加利福尼亚州的居家健康数据记录了在医疗保险和医疗补助制度下导致居家健康服务发展和衰落的主要政策的影响。对这些政策的回顾，在加利福尼亚州数据的支持下，表明居家健康服务因历史发展不足以及立法和监管重点而受到极大限制。此外，该研究指出了当前所收集数据类型的局限性，并提出了未来居家健康项目评估和规划所需的数据要求。
