Home- and community-based long-term care: lessons from Denmark.
OBJECTIVE
Denmark is cited as a model in the development of home- and community-based systems for the frail elderly population. We examined the results of this natural experiment and considered implications for U.S. policy.


METHODS
We used international comparative policy analysis, including site visits and semistructured interviews with Danish leadership in conjunction with a review of published literature, reports, and administrative data from Denmark and the United States.


RESULTS
After 12 years of implementing integrated systems for home- and community-based services in 275 municipalities, growth in Danish long-term care expenditures has leveled off; expenditures appear to be decreasing for the over-80 population and have dropped as a percentage of the gross domestic product. Access to and quality of long-term care services appear to remain generally satisfactory. During this period, comparable expenditures in the United States have increased, and deficits in access and quality persist.


CONCLUSIONS
These findings should be of interest to state and federal policy makers considering strategies to reduce the rate of growth in Medicaid and Medicare expenditures for elders and to expand home- and community-based services.
Stuart
M
M
Department of Sociology and Anthropology, University of Maryland-Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA. stuart@umbc.edu
Weinrich
M
M
D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000191:economics*; D017046:Cost Savings / Q000639:trends; D003431:Cross-Cultural Comparison; D003718:Denmark; D005260:Female; D005544:Forecasting; D005102:Health Expenditures / Q000639:trends; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D009313:National Health Programs / Q000191:economics*; D011157:Population Dynamics; D014481:United States