Related Experiment Videos
The closing of a social HMO: a case study
L R Fischer1, W Leutz, A Miller
1HealthPartners Research Foundation, Minneapolis, MN 55440-1309, USA. Lucy.R.Fischer@HealthPartners.com
Journal of Aging & Social Policy
|December 8, 1997
Summary
The closure of a social health maintenance organization (SHMO) led to elderly individuals receiving less care and paying more, resulting in unstable long-term care arrangements.
Area of Science:
- Gerontology
- Health Services Research
- Social Work
Background:
- Social health maintenance organizations (SHMOs) integrate acute and long-term care, offering extended benefits to at-risk elderly populations.
- SHMOs aim to prevent institutionalization by providing comprehensive care coordination and long-term support.
- The termination of SHMO programs can significantly impact the continuity and stability of care for vulnerable elderly individuals.
Purpose of the Study:
- To investigate the consequences of a SHMO's termination on elderly recipients of long-term care.
- To examine the transition process and the replacement of care coordination and services after SHMO closure.
- To understand the experiences of at-risk elderly and their caregivers following the discontinuation of SHMO benefits.
Main Methods:
- A case study approach was employed to analyze the termination of the Group Health SHMO in Minnesota.
- Qualitative data were collected through interviews with social workers and elderly individuals receiving long-term care.
- The study focused on the post-SHMO transition, care replacement, and the stability of the care system.
Main Results:
- Most elderly participants and their caregivers reported experiencing a decline in care quality and an increase in costs, describing it as "losing ground."
- Following the SHMO closure, participants frequently shifted to private-pay arrangements and increased reliance on informal care networks.
- The transition resulted in a less stable care system for the elderly individuals studied.
Conclusions:
- The termination of SHMOs can destabilize long-term care systems for at-risk elderly populations.
- Increased out-of-pocket expenses and reliance on informal care suggest a diminished quality and accessibility of formal long-term care services post-SHMO.
- Policy implications include the need for robust transition planning and sustainable models for integrated long-term care to ensure continuity and stability for elderly beneficiaries.