美国国家长期护理计划. 一个关心的愿景. 长期护理计划设计工作组,国家卫生计划的医生
C Harrington1, C Cassel, C L Estes
1Physicians for a National Health Program, Cambridge Hospital/Harvard Medical School, MA 02139.
JAMA
|December 4, 1991
概括
拟议的国家卫生计划改革将创建一个统一的长期护理 (LTC) 公共计划,确保对所有需要基本服务的个人提供全面的覆盖和支持. 这旨在改善长期护理需求的获取和负担能力.
科学领域:
- 卫生政策和服务研究 研究 研究 卫生政策和服务
- 老年学和长期护理
- 公共卫生管理公共卫生管理.
背景情况:
- 目前的长期护理 (LTC) 融资和提供系统面临重大挑战,包括负担能力问题,基于年龄的访问限制,以及对非正式护理人员的不充分支持.
- 现有的医疗补助政策倾向于机构护理而不是独立生活,并排除不符合狭窄的医疗必要性定义的基本服务.
- 超过三分之一的需要LTC的个人年龄在65岁以下,这凸显了对非年龄特定护理解决方案的需求.
研究的目的:
- 提出一个全面的长期护理 (LTC) 计划,作为国家健康计划的综合组成部分.
- 概述一个医疗和社会必要的LTC服务的普遍覆盖的模型.
- 解决当前LTC资金,访问和服务提供方面的系统性缺陷.
主要方法:
- 一个单一的,联邦授权和资助的公共计划LTC管理在地方层面.
- 建立以州为基础的LTC支付板,通过当地机构与提供商签订合同,以符合资格和护理协调.
- 执行机构提供商的全球预算和综合组织的资本费,逐步淘汰营利性实体.
主要成果:
- 拟议的计划将为所有医疗和社会上必要的LTC服务提供普遍覆盖.
- 它旨在增加对LTC部门创新,人员培训和质量监测的支持.
- 据估计,LTC的年度成本增加在180亿美元至235亿美元之间,民意调查显示公众支持.
结论:
- 拟议的国家LTC计划为当前的系统故障提供了结构性解决方案,提高了护理的获取,负担能力和质量.
- 这种模式促进综合护理提供,并支持多样化的护理环境,包括独立生活.
- 公众愿意通过专项税收资助这样的计划,这表明改革的可行途径.
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