Cost Effectiveness in Community Care for the Elderly. Abstract, Executive Summaryand Final Report

摘要

In this study, we used actuarial and operations research methods to ascertainwheather the performance of community based long term care programs as a means to constrain nursing home use and overall long-term care costs can be improved through rigorous management of service targeting and allocation. Using data from the National Long-term Care Demonstration (Channeling), our results indicate that substantial net reductions in overall long-term care costs (on the order of 10 percent) can be achieved through controlled program expansion accompanied by optimal targeting of resources to those most at risk, along with substantial restructuring of the mix of services provided. Our findings are in marked contrast to the results of the Channeling Demonstration itself, which for the same population was enable to reduce overall long term care costs, and indeed produced large cost increases. Our findings indicate that there are many as yet unrealized efficiences in community based long-term care programs that can be captured through more rigorous management methodologies, possibly involving computerized decision support systems, thereby allowing such programs to better realize their cost containment potential. Indeed, the long sought goal of overall net cost neutrality of reduction can apparently be realized, at least in simulation, in a frail older population of the type screened into the Channeling Demonstration.