Financing Long-Term Care
Journal: Annals of Internal Medicine (1988)

Medicine and Public Issues1 February 1988Financing Long-Term CareAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-108-2-279 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail AbstractAbstractThe availability and delivery of long-term care services in the United States have been hindered by major organizational and financial problems. The American College of Physicians has previously identified and addressed some of the organizational problems that impede access to long-term care. In this issues paper, we provide background information on and analysis of the costs and the methods currently used to finance such care in the United States. The Canadian National Health Care System is also described for comparison. We then analyze such alternative financing mechanisms as private individual insurance (beyond Medigap), employment-based long-term care insurance, self-insurance, vouchers, financing through Medicare, home equity conversions, and prepaid capitated case management plans. The advantages and disadvantages of each of these methods are presented.References1. . Proceedings of the Conference on the Changing Needs of Nursing Home Care. Philadelphia: American College of Physicians; 1980. Google Scholar2. . Long-term care of the elderly. Ann Intern Med. 1984;100:760-3. LinkGoogle Scholar3. . The Role of the VA in an Evolving Health Care System. Washington, D.C.: American College of Physicians; 1985. Google Scholar4. . Home health care. Ann Intern Med. 1986;105:454-60. LinkGoogle Scholar5. . Medicare payment for physician services. Ann Intern Med. 1987;106;151-63. LinkGoogle Scholar6. BOWEN O. Catastrophic Illness Expenses. Washington, D.C.: Department of Health and Human Services; 1986. Google Scholar7. WALDOLAZENBY DH. Demographic characteristics and health care use and expenditures by the aged in the United States: 1977-1984. Health Care Financ Rev. 1984;6:1. Google Scholar8. . Aging America: Trends and Projections, 1985-86. Washington, D.C.: Department of Health and Human Services; 1986. (Publication no. 498-116-814/42395). Google Scholar9. KEELERKANESOLOMON ERD. Short- and long-stay residents of nursing homes. Med Care. 1981;19:363-70. CrossrefMedlineGoogle Scholar10. LIUMANTONLIU KKB. Home care expenses of the disabled elderly. Health Care Financ Rev. 1985;7:51-8. MedlineGoogle Scholar11. . Seven in Ten Elderly Living Alone Are At Risk. Washington, D.C.: U.S. Government Printing Office; 1987. Committee Print 100-631. Google Scholar12. EDMONDSON B. The home health care market. American Demographics. 1985;April:29-51. Google Scholar13. KOREN M. Home care—who cares? N Engl J Med. 1986;314:917-20. CrossrefMedlineGoogle Scholar14. . Long-Term Care Research Study. Washington, D.C: American Association of Retired Persons; 1984. Google Scholar15. GETZENELSENHANS TV. Insuring against poverty from long-term care. Bus Health. 1986;3:20-1. MedlineGoogle Scholar16. CAFFERATA G. National Health Care Expenditures Study, Data Preview 17: Private Health Insurance; Premium Expenditures and Sources of Payment. Rockville, Maryland: National Center for Health Services Research; 1984. DHHS publication no. (PHS) 84-3364. Google Scholar17. CAFFERATA G. Private health insurance of the Medicare population and the Baucus legislation. Med Care. 1985;23:1086-96. CrossrefMedlineGoogle Scholar18. MEINERS M. The State of the Art in Long-Term Care Insurance. Rockville, Maryland: National Center for Health Service Research; 1984. Google Scholar19. CAFFERATA G. The elderly's private insurance coverage of nursing home care. Am J Public Health. 1985;75:655-6. CrossrefMedlineGoogle Scholar20. RICEMCCALL TN. The extent of ownership and the characteristics of Medicare supplemental policies. Inquiry. 1985;22:188-200. MedlineGoogle Scholar21. MATULA B. The cost of caring for long-term illness: the case for insurance. America's Health Care Challenge: New Directions for Business, Government and Individuals: Proceedings of a Symposium in New York, New York on 27 January 1986. New York: Northwestern National Life Insurance Company; 1986:32-34. Google Scholar22. . Fast facts and figures about social security. Soc Secur Bull. 1986;49:5-19. Google Scholar23. IGLEHART J. Canada's health care system: (1). N Engl J Med. 1986;315:202-8. CrossrefMedlineGoogle Scholar24. IGLEHART J. Canada's health care system: (2). N Engl J Med. 1986;315:778-84. CrossrefMedlineGoogle Scholar25. KANEKANE RR. The feasibility of universal long-term care benefits: ideas from Canada. N Engl J Med. 1985;312:1357-64. CrossrefMedlineGoogle Scholar26. ANDERSON G. DataWatch: national medical care spending. Health Aff (Millwood). 1986;5:123-30. CrossrefMedlineGoogle Scholar27. BISHOP C. A compulsory national long-term care insurance program. In: WALLACK S, CALLAHAN J, eds. Reforming the Long-Term Care System. Lexington, Massachusetts: Lexington Books; 1980:61. Google Scholar28. MEINERS M. The case for long-term care insurance. Health Aff. 1983;2:55-79. CrossrefGoogle Scholar29. MEINERS M. Long-term care insurance: an idea whose time has come. Generations. 1985;9:39-42. Google Scholar30. MEINERS M. Private financing of home and community care for the elderly: the insurance option. Perspect Aging. 1986;15:10-12. Google Scholar31. MEINERSGOLLUB MJ. Long-term care insurance: the edge of an emerging market. Healthc Financ Manage. 1984;38:58-62. MedlineGoogle Scholar32. GREENHOUSE S. Health insurance for elderly: a new option. New York Times. 1986 Sept 27. MedlineGoogle Scholar33. WILENSKYFARLEYTAYLOR GPA. Variations in health insurance coverage: benefits vs. premiums. Milbank Mem Fund Q. 1984;62:53-81. CrossrefGoogle Scholar34. . Medigap Insurance: Law Has Increased Protection Against Substandard and Overpriced Policies. Washington, D.C.: U.S. Government Printing Office; 1986. Publication no. GAO/HRD-87-8. Google Scholar35. FARLEY P. Private Insurance and Public Programs: Coverage of Health Services Data Preview 20: National Health Care Expenditure Study. Rockville, Maryland: National Center for Health Services Research and Health Care Technology Assessment, Department of Health and Human Services; 1985. DHHS publication no. (PHS) 85-3374. Google Scholar36. TAYLORLAWSON AW. Employer and Employee Expenditures for Private Health Insurance Data Preview 7: National Health Care Expenditure Study. Rockville, Maryland: National Center for Health Services Research, Department of Health and Human Services; 1981. DHHS publication no. (PHS) 81-3297. Google Scholar37. WESSEL P. IRMA: a long-term home-equity conversion program. Pride Inst J Long Term Home Health Care. 1985;4:29-31. Google Scholar38. KNICKMANMCCALL JN. A prepaid managed approach to LTC. Health Aff (Millwood). 1986;5:90-104. CrossrefMedlineGoogle Scholar39. GREENBERGLEUTZERVINGREENLICKKODNERSELSTAD JWSMDJ. S/HMO: the social/health maintenance organization & long term care. Generations. 1985;9:51-5. Google Scholar40. GREENBERGLEUTZABRAHAMS JWR. The national health maintenance organization demonstration. J Ambulatory Care Manage. 1985;8:32-61. CrossrefMedlineGoogle Scholar41. LEUTZ W. Long-term care for the elderly: public dreams and private realities. Inquiry. 1986;23:134-40. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *This paper was drafted by Jack A. Ginsburg, and developed for the Health and Public Policy Committee by the Health Care Financing Subcommittee: John M. Eisenberg, M.D., Chairman; Robert H. Brook, M.D.; Bruce Samms, MD.; Arthur Feinberg, M.D.; H. Denman Scott, M.D.; and Paul S. Entmacher, M.D. Members of the Health and Public Policy Committee for the 1987-1988 term are Richard G. Farmer, M.D., Chairman; John M. Eisenberg, M.D.; Paul F. Griner, M.D.; Joseph E. Johnson III, M.D.; Michael A. Nevins, M.D.; Donald L. Feinstein, M.D.; Charles E. Lewis, M.D.; Malcolm L. Peterson, M.D. [deceased November 1987]; C. S. Lewis, Jr., M.D.; Steven A. Schroeder, M.D.; and Quentin D. Young, M.D. Ex officio members are Edwin P. Maynard, M.D. and Lawrence Scherr, M.D. This paper was adopted by the Board of Regents on 14 November 1987.▸From the American College of Physicians; Philadelphia, Pennsylvania. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMedical care for institutionalised elderly people in SingaporeFinancing Long-Term Care The Growing DilemmaLong-Term Care: The Need for, and Limits of, an Effective Federal RoleAnne R. SomersFinancing Long-Term CarePaul J. Friedman, MDFinancing Long-Term Care: The Need for a National Health PlanARTHUR W. FEINBERG, M.D. 1 February 1988Volume 108, Issue 2Page: 279-288KeywordsHealth careLong-term careMedicarePrevention, policy, and public healthPublic policy ePublished: 1 December 2008 Issue Published: 1 February 1988 Copyright & Permissions© 1988 American College of PhysiciansPDF downloadLoading ...