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Biomedical subjects

C L Estes

Publications and source records attributed to C L Estes.

54 records · Page 3Linked to original sources
PubMed1984

Women and the economics of aging.

Economic and policy arrangements assure the maintenance of gender-based inequities throughout the life cycle. To understand the economics of aging requires consideration of the problems of women of all ages, commencing early in the adult life cycle when the different social roles and opportunity structures available to men and women take effect. Because the economic inequities suffered by women in old age derive principally from inequities suffered earlier as wives and workers, public policy focused on redressing income in old age does nothing to alter the structural basis of inequity. This article examines factors underlying the economics of aging for older women in the United States; delineates the relation between women's roles, social policy, and income; and raises salient policy questions for younger and older women.

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PubMed1984

A preliminary assessment of the impact of block grants on community mental health centers.

Federal block grants to states implemented under the Reagan administration were designed to shift governmental responsibility to state and local levels. Focusing on the impact of block grants on community mental health centers, the authors consider whether states have the revenue and managerial capacity to administer block grant programs and whether they are willing to address equity issues related to access to services for low-income citizens. They report data from 36 centers in eight states showing that a majority are now receiving lower levels of federal funding and that many have reduced staffing and services as a result. To counteract the loss of federal funds, centers have increased fees and have taken steps to develop services geared toward the private sector. The authors discuss the effect of such changes on the centers and the implications for the centers' low-income clientele.

Budgets↗
PubMed1983

New federalism and health policy.

The making of health policy in the United States is a complex process that involves the private and public sectors, including multiple levels of government. Five characteristics of the policy process are identified, which establish the means by which policies are formulated and which affect the nature of the policies that emerge. These characteristics include (1) the relationship of the government to the private sector; (2) the distribution of authority and responsibility within a federal system of government; (3) the relationship between policy formation and implementation; (4) a pluralistic ideology as the basis of politics; and (5) incrementalism as the strategy for reform. The article focuses on the impact on health policy of the distribution of authority and responsibility within the federal system, particularly the impact of new federalism policies as they emerged during the past decade. The effects of dual federalism, cooperative federalism, creative federalism, and new federalism are examined in relation to health policies. The article concludes with an examination of the challenge to long-established values and health policies posed by new federalism.

Government↗
PubMed1982

Austerity and aging in the United States: 1980 and beyond.

This paper presents a critical examination of the past and future direction of social policies for the aged in the United States. The definitions of the social problem of old age and of the appropriate policy solutions for this problem have reflected the ups and downs of the U.S. economy and the shifting bases of political power during the past thirty years. In the 1980s, three dominant definitions of reality are shaping public policy for the elderly: (a) the perception of fiscal crisis and the necessity for reduced federal expenditures; (b) the perception that national policies should give way to decentralization and block grants; and (c) the perception of old age as an individual problem. It is argued that old age policy in the United States reflects a two-class system of welfare in which benefits are distributed on the basis of legitimacy rather than on the basis of need.

Aged↗
PubMed1981

Policy shifts and their impact on health care for elderly persons.

THREE MAJOR SHIFTS IN FEDERAL POLICY HAVE BEEN INITIATED RECENTLY THAT WILL DIRECTLY AFFECT THE MEDICAL CARE OF THE ELDERLY: (1) A significant reduction in federal expenditures for domestic social programs; (2) decentralization of program authority and responsibility to states, particularly through block grants; (3) deregulation and greater emphasis on market forces and competition to address the problem of continuing increase in the costs of medical care. The federal policy shifts come at a time when many state and local governments are experiencing fiscal strain or fiscal crisis due, in part, to the rapid rise in expenditures for medical care for the poor and the imposition of limitations on, and even reductions in, tax revenues. In the short term, changes at the state level, particularly limitations on Medicaid expenditures, are likely to have the most profound effect on medical care for the elderly. These changes will most likely include reductions in Medicaid eligibility and in scope of benefits as well as tight controls on hospital, nursing home and physician reimbursement.

Aged↗
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

From cottages to condos: the expansion of the home health care industry under Medicare.

The home health care industry has undergone a dramatic period of growth since the passage of Medicare (Title XVIII of the Social Security Act) in 1965. This growth has occurred in both the expansion of the total number of Medicare-certified agencies providing care, as well as the number of clients served and hours of care provided. It has been suggested that the single most important factor in this market expansion was the inclusion of a home care benefit in the original Medicare legislation, thus making it possible for nonprofit home care agencies to rely on a predictable source of government reimbursement. This paper explores the influence that amendments to the Medicare legislation since 1980 have had on market expansion, as well as other federal, state and private policy initiatives that have also influenced this growth. The authors suggest that overall growth does not equate with improved access or availability of needed services in the home for the frail and functionally-impaired elderly. Research findings from the first year of a three year study designed to document the impact of cost containment policies on community-based care for the elderly are reported in summary form to illustrate the authors position.

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PubMedDate not supplied

The United States; long-term and Federal policy.

Examines the need for uniform national policy for the provision of long-term care (LTC) services at an affordable price with access for all in need: points up the relationship between LTC issues and acute care policy; outlines seven basic principles for a comprehensive LTC system; lists problems to be solved and proposes alternative solutions for issues of chronicity, access, and cost control; and urges long-range comprehensive policy reform fo health care delivery and financing.

Aged↗