A legislative infrastructure that fosters case management. The Israeli Long-Term Care Insurance Law

This article presents a legislative infrastructure that fosters the development of case management model and demonstration projects within the framework of the Israeli Long-Term Care Insurance Law of 1988. A brief demographic description of the aged population of Israel is presented along with an outline of the basic policy and service structures. The basic principles of the Long-Term Care Insurance law are presented, discussed and analyzed, outlining the pathways that the law guarantees that foster case management interventions and projects.

A case management demonstration project for the frail elderly in Israel

This article presents an evaluation of an innovative community-based case management demonstration project for the frail elderly in Israel. The evaluation study was part of a nine-countries European project within the framework of the 1999 International Year of the Older People. The Department for the Aged of the Israeli Ministry of Labor and Social Affairs and the author initiated the project. The basis for the project development is described, including institutional structure, workers' qualifications, technical resources, and clients assessment criteria. The findings showed increased quality of life for the elders and their caregivers, more coordination and cooperation between various social and health services, activation of a variety of services, and client satisfaction. Recommendations are made to continue and expand this type of project to a larger segment of the elderly population.

Germany's long-term-care insurance: putting a social insurance model into practice

A growing population of elderly has intensified the demand for long-term care (LTC) services. In response to the mounting need, Germany put into effect a LTC Insurance Act in 1995 that introduced mandatory public or private LTC insurance for the entire population of 82 million. The program was based on the organizational principles that define the German social insurance system. Those individuals in the public system and their employers each pay contributions equal to 0.85 percent of each employee's gross wages or salary. Ten percent of the population with the highest incomes have chosen the option of purchasing private long term care insurance. Provisions were made for uniform eligibility criteria, benefits based on level of care needs, cost containment, and quality assurance. Over the first four years of its operation, the system has proved financially sound and has expanded access to organized LTC services. The German system thus may serve as an example for other countries that are planning to initiate social LTC insurance systems in other nations.

Enabling informed consumer choice in the long-term care insurance market

Provisions in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) may increase private long-term care insurance sales without imposing substantially more stringent consumer-protection features. The ability of consumers to make informed choices when purchasing this complex product is examined in light of these changes. Data were collected through detailed examinations of policies and interviews with industry experts, insurance companies, agents, consumer groups, and regulators. Because of the complexity of this product, the goals of expanding, consumer choice and ensuring that consumers are able to make informed decisions often work against each other. Mechanisms are discussed through which the government can facilitate informed choice and improve consumer protection. The authors contend that, because the government is providing tax incentives that encourage consumers to purchase the product, it has the responsibility to ensure that consumers understand the long-term care insurance they purchase.

Finance issue brief: long-term care insurance

States are turning their attention to long-term care insurance, spurred by a 1996 federal law and an increasingly urgent need for more options to finance the care of their rapidly growing elderly populations.

[A different approach--a new instrument for expert assessment of disability stages?]

A New Tool for Expertising Nursing-Care Need? Since the introduction of the long-term care insurance in April 1995 criticism of the mode of expertise used to assign a particular nursing status to a patient has not ceased. Nursing status is required to receive monetary benefit from the long-term care insurance. According to the code of social law (SGB XI) nursing status is based on the total amount of time in minutes a care-needing person requires help to perform certain activities of daily living (ADL). This time-based classification is the bone of contention. As the currently used classification instrument has not been validated and is not reliable, it has been the aim of the present study to introduce a more objective mode of expertise. In our study we used the Barthel-Index as an instrument that allows to assign nursing status to a person in agreement with the person's respective ability to fulfil ADL. In a prospective study 252 patients were examined by the raters of the MDK Bavaria (Medical Service of Health Insurance) according to the SGB XI and the Barthel-Index. On the basis of the Barthel-Index and a certain discriminatory function more than 86% of the patients were assigned the same nursing status as with the normally used mode of expertise. Most of the differing results were borderline cases between two levels of nursing status. The new mode of expertising results in a more balanced distribution of different levels of nursing status. Therefore, the Barthel-Index in combination with the discriminatory function is as effective as the normally used mode of expertising. It is a valid and reliable instrument which could well replace the mode of expertising used so far.

Options for LTC financing reform: public and private insurance strategies

Private insurance is likely to grow but will probably play only a modest role in financing nursing home and home care. Given the limits of the private sector, greater attention should be given to reforming our public programs.

Congress advances on health care reform: one step at a time

In adopting the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Congress made a series of small but significant steps toward improving access to health care benefits. The Act's centerpiece is its new requirements for group health plans and for the health insurance industry for assuring portability, access, and renewability of health insurance coverage. Of nearly equal importance is the pilot program established for testing the viability of medical savings accounts. Other health-related changes include adjustments in the rules governing duplication and coordinating of Medicare-related plans, recommendations with respect to privacy of health information of employees, an increase in the deduction for health insurance costs for self-employed individuals, and permission for unemployed persons to make withdrawals from IRAs and other qualified plans for certain medical services' costs. This article summarizes these and other key provisions of HIPAA.