Ginsberg G M
Isr J Med Sci. 1985 Mar;21(3):230-7.
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.
1981年，以色列在为老年人口提供服务方面支出了2.62亿美元，其中只有14.3%用于社区护理，而机构护理的支出占比为85.7%。本文旨在探寻一种方法，以确定老年人社区护理与机构护理之间的适当平衡。文中探讨了两种方法：一种基于国际比较，另一种是规范方法。基于国际比较的方法主要用于为变革提供大致的方向指引，该方法表明以色列存在社区服务相对供应不足的情况。为了获取有关老年人所需服务的确切数量和类型的信息，建议采用规范方法。这需要以下步骤：1）专家界定哪些护理套餐与不同功能障碍风险群体相关；2）测量机构和社区中老年人的功能障碍情况；3）为功能障碍亚组划定可行的护理套餐；4）对各种护理套餐进行成本核算（包括考虑功能障碍程度的机构护理差异成本核算），以确定最具成本效益的选项；5）汇总最具成本效益的选项，以估计每种服务的理想提供量。
