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Biomedical subjects

C L Estes

Publications and source records attributed to C L Estes.

At least 37 records · Page 2Linked to original sources
PubMed1990

Public light and private dark: the privatization of home health services for the elderly in the U.S.

The privatization of health care has been a controversial topic that has consumed an increasing share of national attention in both the United Kingdom and the United States. In this paper we consider several definitions of privatization; outline two strategies of privatization--privatization by replacement and privatization by reduction or attrition; identify possible consequences of various policies of privatization for health and social services for the elderly; and offer some ideas about how trends toward privatization may be assessed, utilizing empirical data from research on the impact of medical cost containment and privatization on community-based services in the U.S. That the substance of government policy is moving toward privatization is without question; that these policies may have serious consequences for outcomes of social equity is still under debate. The trends suggested in our research have potentially negative consequences for marginal elderly clients in U.S. If the consequences of privatization can be linked to the denial of service to needy clients, privatization may, indeed, represent a dark alternative to the welfare state.

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PubMed1990

The impact of DRGs on community-based service providers: implications for the elderly.

We investigated changes in community-based agencies following the implementation of the Medicare prospective payment system for hospitals utilizing DRGs (diagnosis-related groups). Data were collected in 1986 and 1987 from 771 community service providers. There were five major findings: 1) hospital discharge planners, nursing homes, and home health agencies experienced DRG effects before other types of community providers studies; 2) the "reach" of DRG impact is widespread; 3) providers report a change in clientele toward a heavier-care client; 4) the impact of DRGs affects the types of services agencies provide; and 5) community providers have experienced a decrease in their ability to refer their clients both to hospitals and to each other.

Aftercare↗
PubMed1989

Geriatric services: community mental health center boon or bane?

The fragmented and uncoordinated development of federal and state mental health policy for the aged, the lifting of federal mandates for CMHC service emphases on the aged, and the underutilization of CMHC services by the aged all raise the issue of the implications of CMHCs emphasis on services to elderly clients. We hypothesized that CMHCs with increases in aged clientele would fare worse in terms of budgets, services, and staffing than those that did not report increases in elderly clientele. The findings are more complex in that, compared to centers with no change in aged clientele, CMHCs fared better when they either had decreases in aged clientele (as expected) or increases in such clientele (in contradiction to the hypothesis), although the former relationship was stronger. These findings are interpreted in terms of the need for CMHCs to specialize either on the aged or on other client populations. Such specialization, and the stronger effect for de-emphasis on the aged, suggest greater barriers to access of the aged to community mental health care.

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PubMed1989

The biomedicalization of aging: dangers and dilemmas.

Medicine, with its focus on individual organic pathology and interventions, has become a powerful and pervasive force in the definition and treatment of aging. The resulting "biomedicalization of aging" socially constructs old age as a process of decremental physical decline and places aging under the domain and control of biomedicine. This paper examines the effects of medicalization on the scientific enterprise and development of the knowledge base in aging, the status and work of the professions, policy, and public perception.

Aging↗
PubMed1989

Federal funding for aging education and research: a decade analysis.

Support for gerontological education and research is analyzed from 1976 through 1986 for five federal agencies: the Administration on Aging, the Bureau of Health Professions, the National Institute on Aging, the National Institute of Mental Health, and the Veterans Administration. It was determined that total federal allocations varied greatly between the social/behavioral and biomedical components of the aging field, with biomedical education and research receiving an increasingly larger percentage of support.

Financing, Government↗
PubMed1988

"Medicalization" of community services for the elderly.

Research on medical care cost containment has indicated that the community-based service system is undergoing a process of restructuring within the context of an increasingly competitive environment and strong pressures to "medicalize" medical care services.

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PubMed1988

Toward a transformation of health and aging policy.

Millions of Americans are plagued by serious problems of inadequate health care benefits, limiting their access to services and creating hardship. For those under 65 years of age, the problem is the lack of insurance for many working poor and others. For the elderly, the problem is one of underinsurance in terms of both cost and coverage, particularly for long-term care. Policies of cost containment and cost shifting to consumers have exacerbated these problems, and current health policy proposals offer little respite. Arguments are made for a program of public national health care. Health policy interventions are considered at four levels: incrementalism, modification, alteration, and transformation. A proposal is presented for universal health benefits that are organized and operated to eliminate for-profit medical care and to promote social and preventive care.

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PubMed1988

The retreat of the state and its transfer of responsibility: the intergenerational war.

In this article, the socially constructed nature of the conflict between the generations, or the "intergenerational war," is explored, with a description of the two major fronts of this battle: a health care financing axis and a caregiving axis. Basic to the health care financing axis is the assumption that certain individuals and populations represent an increasing and unreasonable social burden; the caregiving axis gives ideological support to familial and filial responsibility. The politics of mystification perpetuates the idea that these two axes are unrelated and that generational transfers are independent rather than interdependent. Both permit abdication of the state from social responsibility for human needs and massive budgetary reallocations to defense and tax cuts for the wealthy. An alternative approach derives from the principle of universal life-course entitlement to basic human needs.

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PubMed1986

Community mental health services and the elderly: retrenchment or expansion?

Data gathered from a recent survey of CMHC's suggest that the elderly are increasing their utilization of CMHC services. As more responsibility for mental health services is shifted to the states, a commitment to mental health services for the elderly increasingly becomes an issue of state discretion, and of state finances. This makes it probable that accessibility to mental health services for the elderly will become more variable and problematic on a national basis. This is especially important in light of data that indicates an increasing awareness by CMHC's of the mental health needs of the elderly.

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PubMed1986

Community health centers and the elderly: a potential new alliance.

Community health centers (CHCs) are experiencing the effects of federal policy changes that are promoting an autonomous existence for many agencies. These policy shifts also challenge the original structure and mission of CHCs to serve underserved and/or low-income clientele. CHCs now need not only a stable clientele, but also a reimburseable clientele. Both of these criteria can be met by the elderly population with Medicare coverage. The needs of the CHCs are balanced by the growing needs of the elderly who are using CHCs more, according to the authors' research in 32 communities across the country. The most dramatic increases in CHC clientele between 1983 and 1984 was in the 75 years and older categories. This article reviews the factors underlying CHCs strategic advantage in expanding services to the elderly, the evolution of federal policy toward CHCs, and their response to the current policy environment. The discussion is based on findings from studies conducted between 1982 and 1985.

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PubMed1986

The non-profit sector and community-based care for the elderly in the U.S.: a disappearing resource?

Non-profit health and social service agencies have traditionally been an extremely important element of non-institutional community-based care for the elderly in the U.S. Policy shifts, commencing in 1981, increasingly concerned with medical cost containment are challenging private non-profit sector agencies delivering care to the elderly. At issue is the ability of communities to maintain a viable service sector predicated on service needs and service accessibility, as opposed to a highly discrete, medicalized, and fragmented service delivery system that is available primarily (or only) to those who can pay.

Aged↗
PubMed1986

The aging enterprise: in whose interests?

This paper revisits the aging enterprise in the context of the new competitive business ideology. Public policy has created an aging enterprise that assures that the needs of the aged will be processed and treated as a commodity. The medical-industrial complex, which comprises the most significant part of the aging enterprise, is a primary beneficiary of the recent reformulation of values and expectations vis-a-vis the state and the private sector. The new business ideology in health is aimed not only at controlling costs but, more importantly, at establishing health care as a market good like any other. Issues of access to needed services are raised for Medicare and Medicaid beneficiaries and for the uninsured. Budget cuts, medical cost control, and the market ideology are resulting in greater fragmentation, privatization, and corporatization of services, as indicated by the author's research on the private nonprofit health and social services sector in a sample of 8 states and 32 communities. In this paper, age-segregated politics and policies in the United States are challenged to utilize grass-roots political efforts that cross age and class barriers. Single-interest aging-based policies are criticized as a form of selfish separatism that could supplant an important and vitally needed intergenerational and coalition strategy.

Aged↗