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Long Term Care: Pragmatic Reform Ideas from Europe

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:.

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Long Term Care: Pragmatic Reform Ideas from Europe

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  1. 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

  2. In Western Europe: Broad range of system-wide, social strategies - Funding - Delivery

  3. 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)

  4. 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)

  5. 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

  6. 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)

  7. 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)

  8. 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

  9. 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)

  10. The Core Challenge: 1) Designing Systemic, Social, Culturally Appropriate Adaptations 2) Overcoming Public Sector Paralysis

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