USING STANDARDIZED DATA TO COMPARE ACCESS TO LONG-TERM SERVICES AND SUPPORTS IN FIVE U.S. STATES

摘要

In the United States, access to long term services and supports is restricted, rather than a universal health care “right.” State governments are responsible for setting “level of care” (LOC) policy to identify the persons eligible to receive publicly-funded services. These policies can exert powerful effects on states’ budgets and individuals’ access to care. Standardized assessment data is now being used for LOC determinations, with the hope that objective measurement will ensure the consistent application of these criteria. We compare LOC policies across four US states that have adopted the interRAI Home Care instrument, thus permitting “head-to-head” comparisons. While states’ systems have the same overall goals, individual states vary in their interpretation of LOC policy, using state-specific algorithms created from different combinations of these standardized assessment items. We will apply these several algorithms to data from a fifth state to demonstrate substantial inter-state differences in access.