Chapter 17Health and Long-Term Care Policy and

Programs

Sociology 431

Health and Long-Term Care

Expenditures

Factors Underlying Growing Health Care Costs

◦ Success of modern medical care

◦ Conflict between curative goals of medicine and chronic care needs of older

adults

◦ System of public financing focus on acute care

◦ Lack of comprehensive, integrated health, and long-term care policy and

program

Medicare Medicare

◦ Title XVIII of Social Security Act of 1965

◦ Social insurance program intended to provide financial protection against

cost of hospital and physician care for people > 65

Medigap

◦ Supplemental insurance

Medicare Personal Health Care Spending

in 2003

Home Health Care Under Medicare

Factors that underlie growth in Medicare-funded home care services

◦ Earlier hospital discharges

◦ 1998 class action lawsuit

◦ Increase in number of proprietary home health agencies being reimbursed

◦ Isolated instances of problems with Medicare-funded home health agencies

◦ High-tech home health therapy

Efforts to Reduce Medicare Costs

Prospective-payment system (PPS)

Medicare Catastrophic Health Care Act (MCHCA) 1988

Physician payment reform

1997 reduction in the Medicare program

The National Bipartisan Commission on the Future of

Medicare

Lobbying efforts

The New Medicare

Medicare Plus Choice

◦ Medicare Health Maintenance Organizations/Preferred Provided

Organizations (HMOs/PPOs)

◦ Private insurance plans

◦ Medical savings accounts

Medicare Reform and Prescription Drug Coverage

Medicaid

Medicaid◦ Federal and state means-tested welfare program of medical assistance for

categorically needy, regardless of age ◦ Medicaid makes Medicare affordable for low-income older adults◦ Provides coverage Medicare does not, such as prescription drugs and long-term

care◦ Stands as only public assistance for long term care

Spending for Long-Term Care: 2004

Social Security Block Grants and the Older

American Act (OAA)

Title XX Amendments to Social Security Act and Title II to OAA provide funding

for some non-medical services

◦ Homemaker and chore services

◦ Home-delivered meals

◦ Adult protective services

◦ Adult day care

◦ Foster care

◦ Institutional care

Private Long-Term Care Insurance

Wide disparities exist in older adults’ ability to purchase private

insurance

“Medi-gap” supplement insurance covers

◦ Medicare deductible and co-payments

◦ Items and services not covered by Medicare (hearing aids and eye

glasses)

◦ Charges exceeding amount approved by Medicare

Health and Long-Term Care Reforms

Health Maintenance Organizations (HMOs)

Social Health Maintenance Organizations (SHMOs)

◦ On Lok-”peaceful happy abode”

◦ Programs for the All-Inclusive Care for the Elderly (PACE)