[Introduction of insurance system for long-term care]

The newly proposed insurance system for long-term care aims at providing elderly persons with quality care for their self-reliance. Under the proposed system, elderly persons themselves would choose services. Therefore, for its efficient use of services utilization, more coordination between health and welfare sectors will be required. To fulfill its purpose, specialists in geriatric medicine should take a major role, too. Health care providers will have to take into consideration each elderly person's whole life-style for self-reliance despite their health problems. The medical sector will also need to be familiar with the various procedures which would be essential for the smooth implementation of the system. These include not only the providing of care but also the documentation of care need which is one of the essential materials for the certification of care need which determines the reimbursement for the care.

Public long-term care insurance in Japan

A public long-term care (LTC) insurance program is likely to be introduced to Japan in the year 2000. A consensus on the need for more LTC resources in the rapidly aging society and dissatisfaction with the current system are some of the factors that have contributed to its introduction. Half the costs will be paid by premiums that will be levied on all those older than 40 years, and half will be covered by general taxation. The insurer will be the municipalities with a pooling mechanism at the national level to balance the differences in their demographic structure. The benefits will include institutional care, respite care, day care, home help, visiting nurses, and loan of devices. Eligibility status will be classified into 6 levels that will be determined by assessment of functional and cognitive status. However, there are few mechanisms to limit benefits and contain costs. Problems also exist in the design of the eligibility classification and in the assessment instrument. The proposed LTC insurance system highlights the need for defining what should be included in a "basic package" of LTC as an entitlement for every citizen, for an organizational mechanism and an assessment instrument to deliver services efficiently and equitably, and for physicians to work outside the traditional medical model. To what degree the Japanese public in general, and physicians in particular, is willing to deal with these issues is a challenge for the 21 st century.

[Degree of disability of demented patients as judged by relatives and experts (disability insurance)]

Health insurance companies commission medical expert opinions rating the severity of clinical improvement in order to provide adequate nursing support. We compared these ratings on 28 demented patients with the ratings from carers and with our own examination. The results indicate that the expert opinions underestimated the severity of improvement and adequate support in some of the cases. We discuss whether these discrepancies may be due to the peculiarities of dementia.

Federal tax developments affecting health care organizations--Part 1: New legislation

Health care providers face numerous federal tax law changes in 1997 through legislation, agency rulings, and court decisions. The author provides an overview of these changes. The first part of this two-part series discusses the legislation enacted in 1996 that will affect health care today.

The Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191)

The purpose of this article is to provide a general overview and reference source for the Health Insurance Portability and Accountability Act, which was signed into law by President Clinton last August. The focus of the article is on Title I--Improved Availability and Portability of Health Insurance Coverage, and on Title III--Tax-Related Health Provisions. The author points out that due to the trend towards an incremental approach to health care legislation, this act must be viewed as one of a series of initiatives being taken by the federal government intended to impact the cost of the U.S. health care delivery system.

Long-term care insurance: a private sector challenge

Powerful demographic and economic forces are fueling the looming crisis related to providing medical and social services for the elderly. However, the American public remains largely oblivious to the devastating implications of the need for institutional or home-based care among senior citizens. Employers have a key role to play in resolving the situation by evaluating competing long-term care policies, endorsing the program of a strong carrier, assisting in offering the policies through payroll deduction and educating employees on the importance of selecting policy riders that best meet their evolving needs.

[Determining the extent of nursing care need according to the nursing care insurance law in an interdisciplinary comparison]

The quantifying of care needed is an important issue of the long-term care insurance act in Germany. In the last three decades limits of self-sufficiency have been defined in the context of law, medicine, social science and nursing science. Following these approaches this study distinguishes between determining the limits of self-sufficiency and determining the care needed. On that basis the procedure for determining in the long-term care insurance is analyzed and numerous problems are shown. Arriving at non-optimal results can only be understood in terms of briefly explained background material. One solution could lie in the use or further development of existing models which determine the limits of self-sufficiency on the basis of ADL scales.

Involuntary transfers and discharges of nursing home residents under federal and state law

When, as projected, nearly one out of every four Americans is age sixty-five or more, one out of every four Americans over sixty-five will spend time in a nursing home, and caregiver families scarcely exist, we will no longer be able to avert our eyes from the grim options faced by our senior citizens. Nor will we be able to continue to operate under the comforting but often false illusion that our convenient dispositions are actually serving the best interests of the elderly.

Ways of thinking about the long-term care of the baby-boom cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers--the generational equity/crisis perspective and the generational investment/gradual adjustment perspective are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.