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Biomedical subjects

A E Benjamin

Publications and source records attributed to A E Benjamin.

30 records · Page 2Linked to original sources
PubMed1988

Public policy, federalism, and AIDS.

The AIDS epidemic poses important challenges to the American political system. In the context of AIDS, relationships between the public and private sectors as well as those among federal, state, and local governments have had a significant impact in shaping the nations response to the epidemic. The character of health policy in the United States has in large part been determined by uncertainty regarding the appropriate role of the public sector and by persistent beliefs that the best solutions are private sector ones. Similarly, relationships across levels of government are clouded by concerns about the presumed excesses of centralized (federal) government and the widespread conviction that the most appropriate solutions are state and local ones. AIDS emerged as a public health issue at a point in the early 1980s when a new federal administration was calling for a reduction in public sector and federal responsibility for addressing health and social needs. Since that time, stronger public and federal leadership appears to be developing, and both are essential to forging the policy partnerships between the public and private sectors and across levels of government that are essential to the development of a comprehensive policy response to the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Long-term care and AIDS: perspectives from experience with the elderly.

The driving concern of policy thinking in regard to both the elderly and AIDS patients has been cost containment. It has been presumed that the best way to cut costs, as well as to serve the medical and emotional needs of AIDS patients, is to limit hospital and nursing home stays and expand the role of community-based services. The experience of the elderly has demonstrated, however, that these services have had little impact on the use of institutional care, only limited outcome benefits, and have not reduced the overall costs; rather, they have increased the utilization of all services and total expenditures. In the case of AIDS patients, a preoccupation with community care alternatives to hospitalization fails to acknowledge the central role of medical care in the management of the disease.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Intensive home health care in the United States. Financing as technology.

This paper assesses the impact of mechanisms for financing intensive home health care services in the United States on their utilization. As lengths of stay have decreased in response to prospective payment methods for hospitals, demand has increased for intensive and complex services provided to patients in the home. Third-party payers, however, are willing to satisfy only some of this potential demand that their reimbursement policies have generated. It is the policies of payers rather than the safety and effectiveness of devices and procedures that are the major constraints on the expansion of intensive home health care. We describe the effects of these policies on who receives intensive home health care services, who provides them, what services are provided, how their quality is monitored, and what they cost.

Acute Disease↗
PubMed1986

Determinants of state variations in home health utilization and expenditures under Medicare.

Of the key federal programs that finance in-home services to the elderly, the Medicare program represents the largest and fastest growing. Although Medicare is a federal program, utilization and expenditures for home care vary widely across the states. Building on the work of Feldstein, Scanlon, and others, theory and data are presented that attempt to illuminate reasons why such variations exist. Using program data by state for 1982, nearly three fourths of the variation in home health utilization (R2 = 0.72) is explained by seven state characteristics. About three fifths of the variation in expenditures (R2 = 0.61) is accounted for by six state factors. Of most explanatory importance are home health agency (HHA) supply, need levels, presence of alternative sources of care, sources of referrals, and state resources. The results suggest the need to give more analytic attention to the impact of the market share of proprietary HHAs in explaining expenditure variations and the effects of total supply on utilization and spending.

Aged↗
PubMed1986

State variations in home health expenditures and utilization under Medicare and Medicaid.

Expenditures for home health services provided under Medicare and Medicaid nearly tripled between 1977 and 1982. Utilization and expenditures for home health services vary widely across the states for both programs, and this article examines in some detail the nature and extent of these variations. States vary considerably with respect to relative utilization, visits, and visit-expenditures under Medicare; and states vary in terms the role visits versus visit-reimbursements play in shaping overall costs. The Medicaid program is effectively two programs: New York; and the other states, with eight accounting for half of Medicaid expenditures outside New York.

Health Expenditures↗
PubMed1982

Evaluating the National Health Planning and Resources Development Act: learning from experience?

The future of health planning and regulation is tied to past performance in both a political and intellectual sense. Evidence of success or failure to accomplish program goals will structure partisan debate about the future of PL 93-641; and the experience of the past seven years will provide policy analysts with the raw material from which to build more effective technologies of planning and regulation. This paper discusses a number of analytic factors which jeopardize the integrity of both impact assessment and knowledge development. These include the nature of the program's goals, the difficulties of generating reliable forecasts as to what would have occurred in the program's absence, the likelihood of unintended consequences, and the seeming inevitability of having to work with elaborate multivariate models which contain numerous interaction terms. We argue that without careful analysis and cautious interpretation, grand experiments such as PL 93-641 are likely to yield little useful evidence to guide policy adaptation.

Health Planning↗
PubMed1980

Elders and children: patterns of public policy in the fifty states.

Relatively little is known about the precise nature of relationships between state policies toward the elderly, on the one hand, and children, on the other. Correlational and regression analysis are used in the present research to examine patterns of association between selected state policy outputs for elders and children. The degree to which they reflect general state orientations toward human services rather than more particularistic orientations toward specific groups is also examined. A model of partial interdependence between policy outputs is supported by the data. About one-half of the variation in aging outputs can be explained by variations in children's policy. A closer examination of Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) grants suggests that policy relationships differ within subsets of states as output levels increase. These findings may have important implications for the range of influence available to aging activists.

Aged↗
PubMedDate not supplied

Consumer-directed services at home: a new model for persons with disabilities.

The past decade has produced a wave of new state programs that have introduced consumer direction into home-based services for persons with chronic impairments. Building upon earlier models developed for younger adults with physical disabilities, consumer-directed models are now being adapted to recipients of all ages with federal, state, and foundation support. These models shift responsibility for key service decisions from professionals to recipients and challenge the traditional home care agency model. Research evidence on the impact of consumer direction is just becoming available to policymakers. This paper reviews what we have learned from program and research activity so far, and what key issues and challenges remain.

Case Management↗
PubMedDate not supplied

Intergenerational equity and public spending.

Concerns over public spending for elders and children are not new. Some of our previous work, combined with the analysis by Susmita Pati and colleagues in this volume of Health Affairs, documents a substantial divergence of social welfare spending for children and elders between 1965 and 2000. Looking to the future, our concern is that social welfare spending for children and elders will be driven more by political concerns and macroeconomic trends than by the needs of the two populations. We argue that the country needs to adopt a new fairness doctrine in allocating social welfare resources, whereby the needs of both groups are met.

Aged↗