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首页> 外文学位 >The cost-effectiveness of community based long-term care services for the elderly compared to residential care: A British Columbia perspective.
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The cost-effectiveness of community based long-term care services for the elderly compared to residential care: A British Columbia perspective.

机译：不列颠哥伦比亚省的观点是，与社区护理相比，社区为老人提供的长期护理服务的成本效益。

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Growth in the elderly population and restraint in the health sector have led to decision makers placing an increasing priority on home care services. In Canada, there are three models of home care: a preventive and maintenance model which is designed to reduce the rate of deterioration for persons with relatively low level care needs; an acute care substitution model where home care substitutes for hospital care; and a long term care substitution model which uses home care as a substitute for facility care. This study focuses on the long term care substitution model. The research question is: In the British Columbia continuing care sector, is home care for the elderly a cost-effective alternative for government funders to care in long term care facilities, by level of care?; To answer this question, data were obtained on three cohorts of clients for one year prior to initial assessment and three years post-assessment. The cohorts were new admissions to the British Columbia continuing care system in the 1987/88, 1990/91 and 1993/94 fiscal years. Costs to government for home care services, residential services, pharmaceuticals, fee-for-service physician services and hospital services were analyzed.; The central finding of this study was that, on average, the overall health care costs to government for clients in home care are about one half to three quarters of the costs for clients in facility care, by level of care. A related finding was that costs differ by the type of client. The lowest home care costs were for individuals who were stable in their type and level of care. For clients who died the costs for home care were higher, compared to clients in long term care facilities. It was also found that some one half of the overall health care costs for home care clients were attributable to their use of acute care hospital services and that a significant portion of the health costs for home care clients occur at transition points, that is, when there is a change in the client's type, and/or level, of care.; These findings are compared to the American literature which indicates that home care is not a cost-effective substitute for residential care. Possible reasons for the differences in findings are discussed. The study concludes with a discussion of the implications of the findings for a series of potential, future, policy agendas regarding: the organization and management of continuing care services; legislation and administrative policy; service delivery; resource allocation; information systems; and research.
机译：老年人口的增长和卫生部门的束缚已导致决策者越来越重视家庭护理服务。在加拿大，有三种家庭护理模式：一种预防和维护模式，旨在减少那些护理水平相对较低的人的病情恶化；一种急性护理替代模型，其中家庭护理替代了医院护理；以及长期护理替代模型，该模型使用家庭护理替代设施护理。这项研究侧重于长期护理替代模型。研究的问题是：在不列颠哥伦比亚省的持续护理部门中，按照护水平，老年人家庭护理是否是政府出资者在长期护理设施中照料的经济有效替代方案？为了回答这个问题，在最初评估之前的一年和评估后的三年中，获得了三组客户的数据。这些队列是1987 / 88、1990 / 91和1993/94财政年度不列颠哥伦比亚省持续护理系统的新招生。分析了政府在家庭护理服务，住宅服务，药品，按服务收费的医师服务和医院服务方面的成本。这项研究的主要发现是，按护理级别划分，平均而言，政府为家庭护理客户提供的总体医疗保健费用约为设施护理客户向政府提供的总体医疗费用的一半至四分之三。一个相关的发现是，成本因客户类型而异。家庭护理成本最低的是其护理类型和水平稳定的个人。与长期护理机构的客户相比，死亡的客户的家庭护理费用更高。还发现，家庭护理客户的总体医疗保健费用中约有一半是由于他们使用急诊医院服务而引起的，而且家庭护理客户的医疗保健费用中很大一部分发生在过渡点，即服务对象的类型和/或级别有所变化；将这些发现与美国文献进行了比较，后者表明家庭护理并不是代替住宿护理的经济有效的替代品。讨论结果差异的可能原因。研究结束时讨论了调查结果对一系列潜在的，未来的政策议程的影响，这些议程涉及：持续护理服务的组织和管理；立法和行政政策；服务提供；资源分配;信息系统;和研究。

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