Balance of care in services to the elderly in Israel.

In 1981, of the $262 million spent in Israel on services for its elderly population, only 14.3% was spent on care in the community--compared with 85.7% on institutional care. This paper searches for a method to determine the appropriate balance between community care and institutional care for the elderly. Two methods are explored: one based upon international comparisons, and the other a normative method. The method that uses international comparisons, which serves primarily to provide rough directional guidelines for changes, suggests the existence of a relative underprovision of community services in Israel. In order to get information as to the exact amount and type of services that are needed for the elderly, a normative approach is recommended. This calls for the following steps: 1) definition by experts of what packages of care are relevant for the various dysfunctional risk groups; 2) measurement of dysfunction among the elderly, both in institutions and in the community; 3) delineation of feasible packages of care for the dysfunctional subgroups; 4) costing of the various care packages (including a differential costing for institutional care that takes into account dysfunctional levels) to identify the most cost-effective option; and 5) aggregation of the most cost-effective options in order to estimate the ideal amount of provision of each type of service.