Steel K, Markson E, Crescenzi C, Hoffman S, Bissonnette A
Med Care. 1982 Nov;20(11):1090-1100. doi: 10.1097/00005650-198211000-00004.
The challenge facing national policymakers is to provide health care that is comprehensive and cost-effective to our nation's growing population of elderly people. A solution worthy of consideration is the use of health maintenance organizations (HMOs) in this capacity. An analysis of the services provided by a multidisciplinary health care system to 150 inner-city elderly, many of whom were "homebound," reversal 1) this population is not homogeneous with respect to severity of disease and service utilization, and 2) a total mean cost per individual per year of $2,021.34 covers: physician, nursing, and social service home visits; visiting nurse, homemakers, home health aide, occupational therapy and physical therapy services; outpatient, laboratory and medication costs. These findings suggest that while costs for those over 65 are many times the per capita costs of younger enrollees, these costs may be significantly less than the costs of institutional care. Further investigation of the costs of maintaining low-income inner-city old, as well as other elderly populations, at home is vital to planning for future long-term care.
国家政策制定者面临的挑战是为我国不断增长的老年人口提供全面且具成本效益的医疗保健服务。一个值得考虑的解决方案是利用健康维护组织（HMO）来承担这一职责。对一个多学科医疗保健系统为150名市中心区老年人（其中许多人“行动不便”）提供的服务进行的分析表明：1）这一人群在疾病严重程度和服务利用方面并非同质化；2）每人每年平均总费用2,021.34美元涵盖了：医生、护理和社会服务上门探访；访视护士、家政服务人员、家庭健康助理、职业治疗和物理治疗服务；门诊、实验室及药物费用。这些研究结果表明，虽然65岁以上人群的费用是年轻参保人员人均费用的许多倍，但这些费用可能远低于机构护理的费用。进一步调查维持市中心区低收入老年人以及其他老年人群居家护理的成本，对于未来长期护理规划至关重要。
