米国における全国的な長期介護プログラムです. 思いやりに満ちたビジョン. 長期介護プログラム設計に関する作業部会,国家保健プログラムのための医師
C Harrington1, C Cassel, C L Estes
1Physicians for a National Health Program, Cambridge Hospital/Harvard Medical School, MA 02139.
JAMA
|December 4, 1991
まとめ
提案された国家保健プログラム改革は,長期的なケア (LTC) のための統一された公的計画を作成し,基本的サービスを必要とするすべての個人に包括的なカバーとサポートを確保します. これは,長期的なケアニーズへのアクセスと手頃な価格を改善することを目的としています.
科学分野:
- 医療政策とサービス 研究 研究 医療政策とサービス
- ゲロントロジーと長期介護
- 公共衛生管理局は公衆衛生管理局として運営されています.
背景:
- 現在の長期介護 (LTC) 資金調達と提供システムは,手頃な価格の問題,年齢に基づくアクセス制限,非公式の介護者に対する不十分なサポートを含む重大な課題を提示しています.
- 既存のメディケイドの政策は,独立した生活よりも制度的ケアを好み,狭い医療的必要性定義を満たさない必須サービスを除外しています.
- LTCを必要とする人の3分の1以上は65歳未満で,年齢別でないケアソリューションの必要性を強調しています.
研究 の 目的:
- 全面的な長期ケア (LTC) プログラムを,国家保健計画の統合構成要素として提案する.
- 医療および社会的に必要なLTCサービスの普遍的なカバーのためのモデルを概説する.
- 現在のLTCの資金調達,アクセス,サービス提供におけるシステム上の欠陥を解決する.
主な方法:
- 地方レベルで管理されるLTCのための単一の,連邦が委託し,資金提供する公共計画.
- 適格性およびケアコーディネーションのための地元の機関を通じてプロバイダーと契約するための州ベースのLTC支払いボードの設立.
- 組織的なプロバイダのためのグローバル予算の実施と,統合された組織のためのキャピテーション手数料,営利目的のエンティティの段階的な廃止.
主要な成果:
- 提案されたプログラムは,医療および社会的に必要なすべてのLTCサービスを普遍的にカバーします.
- LTC部門におけるイノベーション,人事研修,品質モニタリングへの支援を拡大することを目的としています.
- LTCの年間コスト増加額は18~235億ドルと推定され,世論調査で公的支持が示されている.
結論:
- 提案された国家LTCプログラムは,現在のシステム障害に対する構造的な解決策を提供し,医療のアクセス,手頃な価格,質を向上させています.
- このモデルは,統合されたケア提供を促進し,独立生活を含む多様なケア環境をサポートします.
- このようなプログラムに課税金による資金提供に対する市民の意思は,改革の実行可能な道を示唆している.
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