title: Titrating versus targeting home care services to frail elderly clients: an application of agency theory and cost-benefit analysis to home care policy.
abstract: The article summarizes the shortcomings of current home care targeting policy, provides a conceptual framework for understanding the sources of its problems, and proposes an alternative resource allocation method. Methods required for different aspects of the study included synthesis of the published literature, regression analysis of risk predictors, and comparison of actual resource allocations with simulated budgets. Problems of imperfect agency ranging from unclear goals and inappropriate incentives to lack of information about the marginal effectiveness of home care could be mitigated with an improved budgeting method that combines client selection and resource allocation. No program can produce its best outcome performance when its goals are unclear and its technology is unstandardized. Titration of care would reallocate resources to maximize marginal benefit for marginal cost.
authors.affiliation: University of Michigan, USA.
authors.forename: William
authors.initials: W
authors.lastname: Weissert
authors.forename: Michael
authors.initials: M
authors.lastname: Chernew
authors.forename: Richard
authors.initials: R
authors.lastname: Hirth
mesh_terms: D000368:Aged; D019090:Case Management; D003365:Costs and Cost Analysis; D004608:Eligibility Determination; D016330:Frail Elderly; D015276:Health Care Rationing / Q000458:organization & administration*; D006299:Health Services for the Aged; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D012306:Risk; D014481:United States