Search PubMed⌕ Search

Biomedical subjects

J M Wiener

Publications and source records attributed to J M Wiener.

At least 19 recordsLinked to original sources
PubMed2001

What happened to long-term care in the health reform debate of 1993-1994? Lessons for the future.

During 1993 and 1994, the United States debated but did not enact major health care reform. Although the reform efforts focused on providing health coverage for the uninsured and controlling acute care costs, many proposals included substantial long-term care initiatives. President Clinton proposed creating a large home-care program for severely disabled people of all ages and all income groups, among several other initiatives. By stressing non-means-tested public programs, the president's plan was a major departure from the Medicaid-dominated financing system for long-term care. In designing the long-term care component, the Clinton administration addressed many of the basic policy choices that must be decided in all reform efforts, including whether initiatives should be limited to older people or cover people of any age, how to balance institutional and noninstitutional care, whether to rely on government programs or on the private sector, and how to control costs. Analyzing the political and intellectual history of long-term care during the health reform debate provides lessons for future reform.

Aged↗
PubMed2001

Consumer-directed home and community services programs in eight states: policy issues for older people and government.

This study assesses consumer-directed home and community services for older persons by examining public programs that serve this population in eight states. These programs give beneficiaries, rather than agencies, the power to hire, train, supervise, and fire workers. Most stakeholders interviewed, in addition to the quantitative research, indicate that many older beneficiaries want to and can manage their services, although significant issues arise for persons with cognitive impairments. Research results suggest better, or, at least, no worse, quality of life for beneficiaries when they direct their services, although quality of services remains a contentious issue. For workers, consumer-directed care has some disadvantages, including fewer fringe benefits. With exceptions, state agencies have not provided extensive consumer or worker support or aggressively regulated quality of care.

Aged↗
PubMed1999

Public and private responsibilities: home- and community-based services in the United Kingdom and Germany.

In the late 1980s, the United States, the United Kingdom, and Germany had roughly the same system of financing and delivering long-term care. In contrast to the United States, the United Kingdom and Germany enacted radical reform. The United Kingdom converted an open-ended, means-tested national entitlement for institutional care to a block grant to local governments, whereas Germany enacted a nationally uniform, non-means-tested social insurance program. This article analyzes the postreform experience of the United Kingdom and Germany with respect to issues of financing, assessment and case management, and the availability of home- and community-based services. Policy implications for the United States are developed.

Case Management↗
PubMed1999

Controlling the supply of long-term care providers in thirteen states.

Many states have responded to growing Medicaid long-term care expenditures by limiting the number of long-term care providers through certificate-of-need (CON) programs and moratoriums on new construction or certification for participation in the Medicaid program. This article focuses on the use of these policies in 13 states. Most of the 13 states control the supply of nursing home beds and hospital conversions with CONs or moratoriums, but they are struggling to adapt the role of supply policy to the growth of home health and residential care. As an increasing proportion of Medicaid long-term care spending goes to these nursing home alternatives, supply policy needs to keep pace with the changing provider market and the changing demographics of the consumer market if it hopes to ensure access to long-term care and control Medicaid expenditures.

Aged↗
PubMed1996

Can Medicaid long-term care expenditures for the elderly be reduced?

During 1995 and 1996 Congress debated numerous proposals that would dramatically reduce the rate of growth in Medicaid spending, initiatives that inevitably would affect long-term care for the elderly. There are three broad strategies that states might use to control long-term care spending-bring more private resources into the long-term care system to offset Medicaid's expenditures, reform the delivery system so that care can be provided more cheaply, and reduce Medicaid eligibility, reimbursement, and service coverage. Based on the available research evidence, there is little evidence to suggest that large savings are possible without adversely affecting beneficiaries' eligibility, access to services, and quality of care received.

Aged↗
PubMed1996

Financing reform for long-term care: strategies for public and private long-term care insurance.

The way the nation provides for the financing and delivery of long-term care is badly in need of reform. The principal options for change are private insurance, altering Medicaid, and public long-term care insurance. This article uses the Brookings-ICF Long-Term Care Financing Model to evaluate each of these options in terms of affordability, distribution of benefits, and ability to reduce catastrophic out-of-pocket costs. So long as private insurance is aimed at the elderly, its market penetration and ability to finance long-term care will remain severely limited. Affordability is a major problem. Selling to younger persons could solve the affordability problem, but marketing is extremely difficult. Liberalizing Medicaid could help solve the problems of long-term care, but there is little public support for means-tested programs. Finally, universalistic public insurance programs do well in meeting the goals of long-term care reform, but all social insurance programs are expensive and seem politically infeasible in the current political environment.

Aged↗
PubMed1994

Health care reform in the 1990s: where does long-term care fit in?

Although the impetus behind the nation's quest for health care reform is primarily public dissatisfaction over glaring deficiencies in America's acute care system, the way the nation finances and delivers long-term care may be even more badly in need of reform. This article outlines some of the critical policy issues that must be addressed in devising a new national policy for long-term care, with special emphasis on President Clinton's proposal. The focus is on decisions that must be made in designing a major new home-care program.

Decision Making, Organizational↗