Cost-efficiency in Medicaid long-term support services: the role of home and community based services

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England.DesignCross-sectional study using data from 199 150 survey responses.SettingPrimary care and community-based services.ParticipantsRespondents to the 2018 English General Practice Patient Survey with at least one long-term condition.Primary and secondary outcome measuresThe primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors.ResultsThere was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need.ConclusionsLevels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.

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Impact of home and community-based services on hospitalisation and institutionalisation among individuals eligible for long-term care insurance in Japan

BMC Health Services Research ◽

10.1186/1472-6963-10-345 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 44

Author(s):

Naoki Tomita ◽

Kimio Yoshimura ◽

Naoki Ikegami

Keyword(s):

Long Term Care ◽

Community Based ◽

Term Care ◽

Long Term Care Insurance ◽

Community Based Services

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Additional Benefits of Community Managed Forest: A Case Study of Champadevi Community Forest

Nepal Journal of Science and Technology ◽

10.3126/njst.v12i0.6490 ◽

2012 ◽

Vol 12 ◽

pp. 127-132

Author(s):

Bhanu B Panthi

Keyword(s):

Carbon Sequestration ◽

Significant Contribution ◽

Research Area ◽

Environmental Benefits ◽

Managed Forests ◽

Managed Forest ◽

Community Based

This research attempts to identify the existing condition of the community managed forest based on the assumption that it will serve as a proxy for the condition of other forests in the mid hills region of Nepal. The research area has an atypical variation in altitude and diverse pattern of vegetation. This study mainly focuses on estimating carbon content in the forest and identifying the species that has more carbon storage capacity. The research signifies the role of forests in mitigation of ‘Global warming’ and ‘Climate change’ by storing carbon in tree biomass. These types of community based forest management programs are significant for their additional carbon sequestration through the avoidance of deforestation and degradation. The carbon sequestration have a significant contribution to environmental benefits, any shrinkage of forests have an enormous impact on CO2 emission with long term consequences. Thus, the development and expansion of community managed forests provide many benefits to the adjacent community and globally at large.DOI: http://dx.doi.org/10.3126/njst.v12i0.6490 Nepal Journal of Science and Technology 12 (2011) 127-32

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Nursing home admissions for persons with dementia: Role of home‐ and community‐based services

Health Services Research ◽

10.1111/1475-6773.13715 ◽

2021 ◽

Author(s):

Sijiu Wang ◽

Di Yan ◽

Helena Temkin‐Greener ◽

Shubing Cai

Keyword(s):

Nursing Home ◽

Community Based ◽

Community Based Services

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Cost-Efficiency Analysis of Mudarabah Companies

Handbook of Research on Theory and Practice of Global Islamic Finance - Advances in Finance, Accounting, and Economics ◽

10.4018/978-1-7998-0218-1.ch030 ◽

2020 ◽

pp. 568-592

Author(s):

Hadia Sohail ◽

Noman Arshed

Keyword(s):

Cost Efficiency ◽

Cost Minimization ◽

Empirical Studies ◽

Financial System ◽

The Rich ◽

Cost Efficient ◽

Knowledge Intensive ◽

Intensive Approach

The economic system recognizes the role of the financial system as an important cog in its machinery. Several theoretical and empirical studies have evidenced its contributing role to the economy. Within the overall financial system, the Islamic financial system ensures the increase in productivity of capital as well as in the synchronization between the incomes of the rich and the poor. Mudarabah companies stay at the forefront of the Islamic financial system. Their knowledge-intensive approach helps the allocation of resources in long-term ventures and, because of their participation-based setup, they can theoretically cause a trickle-down effect via their redistribution process from the borrower to the lender. Practically, though, this requires the financial institutes such as Mudarabah to be cost-efficient. This chapter explores specifically how efficient Mudarabah companies of Pakistan are in terms of cost minimization, and investigates whether different dimensions of intellectual capital can improve cost efficiency.

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Changing patterns of mental health care in Greece (1984–1996)

European Psychiatry ◽

10.1016/s0924-9338(99)00220-5 ◽

1999 ◽

Vol 14 (8) ◽

pp. 462-467 ◽

Cited By ~ 20

Author(s):

M.G. Madianos ◽

J. Tsiantis ◽

C. Zacharakis

Keyword(s):

Mental Health ◽

Technical Assistance ◽

Psychiatric Care ◽

Significant Shift ◽

Community Based ◽

Mental Hospitals ◽

Reform Programme ◽

Changing Patterns ◽

Community Based Services

SummaryGreece joined the European Community in 1981 and, three years later, the Commission of the European Communities provided financial and technical assistance under EEC Regulation 815/84 for the modernisation of the traditional psychiatric care system, with the emphasis on decentralisation of mental health services and the development of community-based services, as well as on deinstutionalization of long-stay patients and improvement of conditions in public mental hospitals. Over the last 11 years, the implementation of the EEC Reg. 815/84 programme contributed to a significant shift towards extramural care and rehabilitation. The role of the large mental hospitals has gradually been diminished and a large number of long-stay patients have been deinstitutionalised. It is commonly accepted that the EEC-funded psychiatric reform programme, despite inadequacies and constraints, had an impact on the changing mental health scene in Greece.

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Self Help, Not Self Pity': Caring for People with Diabetes in a Voluntary Organisation

Australian Journal of Primary Health ◽

10.1071/py97005 ◽

1997 ◽

Vol 3 (1) ◽

pp. 36

Author(s):

Elica Ristevski ◽

Heather Gardner

Keyword(s):

Health Promotion ◽

Support Services ◽

Cost Efficiency ◽

Service Provision ◽

Voluntary Sector ◽

Voluntary Organisation ◽

Self Help ◽

The Individual ◽

Voluntary Organisations

The importance of the voluntary sector in providing services for people with a chronic illness has been increasingly recognised. A consumer organisation in the voluntary sector, which provides services for people with diabetes, was selected to explore the role of voluntary organisations in service provision. The investigation revealed that voluntary organisations provide support services such as information and education, advocacy, health promotion, the encouragement of research, social activities, and aids and appliances. These services focus on the individual, social, financial and economic needs of people with diabetes and fill the gaps in programs provided by public sector organisations, which are largely targeted toward acute care, are less flexible, and increasingly concerned with cost efficiency. With the shift towards decentralising services to the community and the increased participation of consumers in health care, the work of voluntary organisations will become even more indispensable in Australia.

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Profile of Long-Term Care Recipients Receiving Home and Community-Based Services and the Factors That Influence Utilization in Taiwan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082649 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2649

Author(s):

Chia-Mei Shih ◽

Yu-Hua Wang ◽

Li-Fan Liu ◽

Jung-Hua Wu

Keyword(s):

Low Income ◽

Long Term Care ◽

Common Factor ◽

Behavioral Model ◽

Care Needs ◽

Community Based ◽

Term Care ◽

Care Recipients ◽

Community Based Services

In response to the irreversible aging trend, the Taiwan government has promoted the Long-Term Care (LTC) policy 1.0 launched in 2007 and the LTC policy 2.0 reform since 2016. This study aimed to explore the utilization of formal home and community-based care under LTC policy 1.0 to add scientific support for the on-going LTC policy 2.0 reform. Methods: By using Andersen and Aday’s behavioral model of healthcare utilization, the long-term care dataset was analyzed from 2013 to 2016. A total of 101,457 care recipients were identified after data cleaning. Results: The results revealed that about 40.7% of the care recipients stayed in the care system for more than two years. A common factor influencing the length of home and community-based services (HCBS) utilization period included need factors, where more dependent recipients leave the LTC system regardless of their socio-economic status. However, the utilization period of non-low-income households is significantly affected by the level of service resources. Conclusion: For long-term care needs, the phenomenon of a short utilization period was concerning. This study adds information which suggests policy should reconsider care capacity and quality, especially for moderate to severely dependent recipients. This will allow for better understanding to help maintain care recipients in their own communities to achieve the goal of having an aging in place policy.

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EFFECTIVENESS OF HOME- AND COMMUNITY-BASED SERVICES IN DECREASING HEALTH CARE EXPENDITURE IN TAIWAN

Innovation in Aging ◽

10.1093/geroni/igz038.570 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S159-S159

Author(s):

Ya-Mei Chen ◽

Hsiao-Wei Yu ◽

Ying-Chieh Wang

Keyword(s):

Primary Care ◽

Health Care ◽

Long Term Care ◽

Community Based ◽

Term Care ◽

Care Recipients ◽

Home Based ◽

Number Of Visits ◽

Community Based Services

Abstract Ideally, continuum of care involves wide-ranging health and long-term care (LTC) services. Taiwan’s National Health Insurance scheme and 10-Year Long-term Care Plan attempts to provide universal and fundamental services of continuum care. However, the accessibility of these services for care recipients remains unclear. This study aims to examine the effectiveness of continuum care in decreasing the healthcare expenditure of LTC recipients using home- and community-based services (HCBS). Data collated from the 2010–2013 Long-Term Care Service Management System (N = 77,251) were subjected to latent class analysis to identify subgroups of recipients using HCBS. Subsequently, the 1-year primary care expenditure after receiving HCBS was compared through generalized linear modeling. Three discrete HCBS subgroups were found: home-based personal care (HP), home-based health care (HH), and community-based care (CC). No difference in the number of visits to doctors and the average primary care expenses was observed between the HP and HH subgroups. However, considering physical and psychosocial confounders, care recipients in the CC subgroup recorded a higher number of visits to doctors (β = 3.05, SD = 0.25, p < 0.05) and lower primary care expenditure (β = -98.15, SD = 43.17, p = 0.02) than the other two subgroups. These findings suggest that LTC recipients in Taiwan may obtain better continuum care only for CC service recipients. Additionally, community-based LTC services may lower the cost of health expenditure after 1 year.

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