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Long Term Care:
Pragmatic Reform Ideas
from Europe
Richard B Saltman
Department of Health Policy and Management
Rollins School of Public Health
Emory University
European Observatory on Health
Systems and Policies
Brussels
www.observatory.dk
In Western Europe:
Broad range of system-wide,
social strategies
- Funding
- Delivery
Funding Ideas I
MACRO LEVEL : SHI
Separate Social Health Insurance Fund for
long term care:
-national
-universal
-mandatory
-50% employer/50% employee
-in-kind services, and/or
-cash payments to informal carers
(Germany, Austria, Netherlands)
Funding Ideas II:
MICRO LEVEL: CLIENT CONTRACTING
FOR HOME CARE:
Contract-based bidding to provide
services to each client
-
based on IADLs
pre-qualified bidders
client budgets
municipal monitoring/regulation
(Netherlands)
Delivery Ideas I
MESO LEVEL: ELDERLY HEALTH CENTERS
• Modeled on well-child centers
(“pram-distance”)
(center of town)
• Basic medical support
- Nurse staffing to take blood pressure;
give medications
• Several observation beds (2-3 hours)
• Paid for by municipalities
• All elderly welcomed (Netherlands)
• Minimum if any charge
Delivery Ideas II
MESO LEVEL: SYSTEMATIC SUPPORT
TO INFORMAL CARERS
•
•
•
•
•
•
Dedicated Municipal Budget
Telephone Advice
Respite care (if carer gets sick)
Drop off day centers
Training (e.g. moving a heavy patient, etc)
Pension Points towards retirement
(resembles “dagmama”/ Swedish child care)
(Netherlands/Sweden/Germany)
Observation #1
Key Characteristics of European
Long Term Care Strategies:
• Social not individual
• Systematic not piecemeal
• Mandatory funding sources
(taxes or SHI contributions)
• Universal services (open to all)
Observation #2:
Contrast w/ current U.S. strategies for
home care:
• Mostly self-funded/ well-to-do
• Home/ individual based
• Private Insurer driven
• Technology / IT oriented
From Modern Physicians,
April 2, 2007
“Aging Population Spurs Innovation”
John Dannher, M.D.
“connected personal health and fitness products and
services”
“home-based technologies”:
- motion sensers
- video cameras
- telemonitoring
- functional clothing with on- body sensors
- personal wireless networks
- radio frequency identification
(to track movement)
The Core Challenge:
1) Designing Systemic, Social,
Culturally Appropriate Adaptations
2) Overcoming Public Sector
Paralysis