Adding long-term care to Medicare: The Social HMO Experience.
The rancor accompanying the repeal of most of the 1988 Medicare Catastrophic Act reflects both the national need to improve health and long-term care benefits for the elderly and the political obstacles to finding new sources of financing for such benefits. Neither the need nor the obstacles will go away, but policymakers are now likely to look for lower-cost, efficient, and privately funded alternatives. The authors have developed and tested one such approach: the Social Health Maintenance Organization (SHMO). Operating since 1985, the SHMO model integrates community-based, long-term care services into the managed, prepaid HMO design. The four test sites are adding long-term care to Medicare at no extra cost to the government and only modest premiums for the 17,000 current members. Although the benefits offer limited protection for long-term nursing home care, they do cover long-term care in community settings, where people tend to prefer to stay. Also, integration of the acute and long-term care systems improves the ability to respond to the medical needs of frail members, who also have high acute-care use. The SHMO's model of front-end, community-oriented, long-term care benefits integrated with Medicare appears to be a practical, affordable, and clinically appropriate way to address the rising concern with the lack of coverage and services for long-term care.
Leutz
W N
WN
Brandeis University, Waltham, Massachusetts, USA.
Greenlick
M
M
Ervin
S
S
Feldman
E
E
Malone
J
J
D000368:Aged; D003191:Comprehensive Health Care / Q000191:economics / Q000458:organization & administration; D003365:Costs and Cost Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration*; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007353:Insurance, Long-Term Care / Q000191:economics; D006278:Medicare / Q000191:economics / Q000458:organization & administration*; D017146:Models, Organizational; D014481:United States