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Biomedical subjects

P Kemper

Publications and source records attributed to P Kemper.

49 records · Page 3Linked to original sources
PubMed1990

Case management agency systems of administering long-term care: evidence from the channeling demonstration.

Proposals to expand public financing of home care are currently receiving serious consideration. This paper examines what was learned from the Channeling demonstration about the potential of case management agency systems for administering home care benefits. The Channeling experience points to a number of potential advantages: substitution of lower cost for higher cost services, negotiation of lower prices for services, and quality assurance. It also identified potential disadvantages: difficulty controlling participation rates and the high cost of the case management agency system itself.

Aged↗
PubMed1990

The risk of nursing home use in later life.

Data from the 1982-1984 National Long-Term Care Survey were used in this paper to estimate the risk of nursing home use. The data revealed that 37% of a nationally representative sample of individuals dying between 1982 and 1984 used a nursing home sometime after turning 65. This proportion increased with longevity and was higher among females and whites and in the North Central and Western regions of the country. Because individuals now turning 65 have a longer life expectancy than the persons studied, they face an even higher remaining lifetime risk of nursing home use (43%). Assuming that past utilization patterns will continue, over half of the women and almost one-third of the men turning 65 in 1990 can be expected to use a nursing home sometime before they die.

Age Factors↗
PubMed1989

Spouses and children of disabled elders: how large a constituency for long-term care reform?

Over 13 million adults in the United States have disabled elderly parents or spouses and are potential providers of long-term care, financial assistance, or emotional support. Articles in the popular press notwithstanding, data from the 1984 National Long-term Care Survey indicate that a relatively small number of adult children and spouses assume the multiple responsibilities of elder care and child care or employment. These individuals form a subset of a much larger group of 4.2 million persons, however, who care for disabled parents or spouses. Current and future availability of spouses and children need to be considered in estimating the demand for formal long-term care and the costs of public programs.

Activities of Daily Living↗
PubMed1988

The evaluation of the National Long Term Care Demonstration. 1. An overview of the channeling demonstration and its evaluation.

The channeling demonstration sought to substitute community care for nursing home care to reduce long-term care costs and improve the quality of life of elderly clients and the family members and friends who care for them. Two interventions were tested, each in five sites; both had comprehensive case management at their core. One model added a small amount of additional funding for direct community services to fill the gaps in the existing system; the other substantially expanded coverage of community services regardless of categorical eligibility under existing programs. The demonstration was evaluated using a randomized experimental design to test the effects of channeling on use of community care, nursing homes, hospitals, and informal caregiving, and on measures of the quality of life of clients and their informal caregivers. Data were obtained from interviews with clients and informal caregivers; service use and cost records came from Medicare, Medicaid, channeling, and providers; and death records for an 18-month follow-up period were examined.

Aged↗
PubMed1988

The evaluation of the National Long Term Care Demonstration. 10. Overview of the findings.

The channeling demonstration sought to substitute community care for nursing home care through comprehensive case management and expanded community services. The channeling intervention was implemented largely according to design. Although the population served was, as intended, extremely frail, it turned out not to be at high risk of nursing home placement. The costs of the additional case management and community services--provided in most cases to clients who would not have entered nursing homes even without channeling--were not offset by reductions in the cost of nursing home use. Hence, total costs increased. The expanded formal community care did not, however, result in a substantial reduction in informal caregiving. Moreover, channeling benefited clients, and the family and friends who cared for them, in several ways: increased services, reduced unmet needs, increased confidence in receipt of care and satisfaction with arrangements for it, and increased satisfaction with life. Expansion of case management and community services beyond what already exists, then, must be justified on the basis not of cost savings but of benefits to clients and their caregivers.

Aged↗
PubMed1988

The evaluation of the National Long Term Care Demonstration. 4. Case management under channeling.

The channeling demonstration involved provision of comprehensive case management and direct service expansion. This article considers the former. Under both models, comprehensive case management was implemented largely as intended; moreover, channeling substantially increased the receipt of comprehensive care management. However, channeling was not a pure test of the effect of comprehensive case management: roughly 10-20 percent of control group members received comparable case management services. This was particularly the case for the financial control model. Thus, the demonstration was not a test of case management compared to no case management; rather, it compared channeling case management to the existing community care system, which already was providing comprehensive case management to some of the population eligible for channeling.

Aged↗
PubMed1987

Community care demonstrations: what have we learned?

Based on a review of community care demonstrations, we conclude that expanding public financing of community services beyond what already exists is likely to increase costs. Small nursing home cost reductions are more than offset by the increased costs of providing services to those who would remain at home even without the expanded services. However, expanded community services appear to make people better off and not to cause substantial reductions in family caregiving. Policymakers should move beyond asking whether expanding community care will reduce costs to addressing how much community care society is willing to pay for, who should receive it, and how it can be delivered efficiently.

Community Health Services↗
PubMed1983

Design issues for evaluations of community care demonstrations.

The evaluation of community care demonstrations poses a number of interdependent program and methodological design choices. Whether or not the program to be tested has a system-wide mission, for example, determines whether the program should be implemented on a small or large scale. This in turn has important implications for whether a randomized or a comparison site design is the appropriate evaluation methodology. This paper examines the relation between system-wide mission and scale considerations, on the one hand, and appropriate choice of methodology, on the other. It concludes that a small scale program with a randomized evaluation design is easiest to implement, costs less, and is more likely to provide defensible answers to a limited set of policy questions than a large scale program with a system-wide mission evaluated using a comparison site methodology. Despite the greater difficulty and cost of a large scale demonstration, however, such a demonstration should be seriously considered whenever increased funding makes it a feasible option, because it is able to address a number of significant policy questions that cannot be answered within the constraints of a small scale demonstration.

Community Health Services↗
PubMed1983

The National Long Term Care Demonstration: operational issues encountered in developing the research design.

This paper describes the design of the National Long Term Care Demonstration and its evaluation and discusses a number of operational issues encountered in the design process: simultaneous design of research and operations, identification of the target population, randomization, collection of comparable data, development of an assessment instrument, potential changes in existing programs, and termination planning.

Health Services Research↗
PubMedDate not supplied

Do HMOs make a difference? Introduction.

The study presented in this and the following five papers analyzes how health maintenance organizations (HMOs) affect privately insured individuals' access to health care, use of services, and assessments of care. Using a common data source and methodology, the study examines differences in a broad range of measures between HMOs and other types of insurance, controlling for health status and an extensive set of other individual characteristics and market location. HMO/non-HMO differences also are examined across population subgroups defined by health status, income, race, and age. Data come from the Community Tracking Study Household Survey, a recent, large national survey. Findings show that a person's type of health insurance coverage has little effect on the likelihood of unmet or delayed needs for medical care in the aggregate, but the types of access problems faced by HMO and non-HMO enrollees differ. HMO enrollees are less likely to face financial barriers to care, but more likely to face barriers related to the organization of care delivery. HMO enrollees use more ambulatory and preventive care, but results show no differences in hospital, surgery, and emergency room use. Compared with other types of insurance, physician visits under HMOs are more likely to be to primary care physicians than to specialists. Finally, across nearly all measures of patients' satisfaction, ratings of their last doctor's visit, and trust in their physicians, HMO enrollees' assessments of care are lower than those of people not in HMOs. Across all measures, the study finds few subgroup differences.

Age Factors↗
PubMedDate not supplied

Do HMOs make a difference? Use of health services.

This study analyzes the effects of health maintenance organizations (HMOs) on the use of health services by the privately insured, nonelderly population. After controlling for population and location differences, HMOs increase physician visits, nonphysician practitioner visits, and total ambulatory visits by modest but significant margins, while shifting the mix of physician care from specialists to primary care physicians. HMOs also increase use of two preventive services: mammography screening and flu shots. Contrary to expectation, however, the study finds no significant differences between HMO and non-HMO enrollees in the use of hospital, surgery, and emergency room services.

Adult↗
PubMedDate not supplied

Do HMOs make a difference? Summary and implications.

The findings of this study of the effects of health maintenance organizations (HMOs) have implications for consumers' choice between HMOs and other types of insurance: consumers face a trade-off that flows in part from the design of HMOs. HMO enrollees get more primary and preventive care and face lower out-of-pocket costs, but they get less specialist care, experience more provider access and organizational barriers to care, and report less satisfaction, lower ratings of care, and less trust in their physicians. Policymakers should recognize that this trade-off will be attractive to some people but not to others.

Choice Behavior↗