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R J Newcomer

Publications and source records attributed to R J Newcomer.

12 recordsLinked to original sources
PubMed2001

Health and long-term care for people with Alzheimer's disease and related dementias: policy research issues.

Policy research into the service needs of persons with dementia had its origin looking at challenges confronting caregivers--extended hours of instrumental task assistance, social isolation, fatigue, depression--and how public policy might support informal care-giving while saving public expenditures from nursing home care. This paper, drawing on the experience of the Medicare Alzheimer's Disease Demonstration and other work, provides suggestions for extending care and financing considerations to include health care use and the medical management of chronic health conditions. Basic research is needed to document current use and risk factors, as is experimentation with clinical and other interventions designed to achieve desired quality of care and cost outcomes. This section of the paper will be of direct interest to both US and international readers. The second half of the paper reviews the US state role in regulating and financing nursing homes, home and community-based care, and residential care. All these sectors have high rates of staff turnover, staff shortages, and concerns with quality of care. The international community and US states provide naturally occurring opportunities for delivery system experimentation and innovation. Research taking advantage of these opportunities could greatly inform public policy.

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PubMed1993

Medical services in social health maintenance organizations.

An evaluation of medical services for elderly members in the Social Health Maintenance Organization (SHMO) demonstrations is presented. The SHMOs generally failed to offer special geriatric medical services to the frail elderly, and the coordination of SHMO medical services with the special long-term care and case management services offered by the SHMOs was limited. These limitations led to some problems for the elderly in terms of access, continuity of care, and satisfaction. Variations in medical services occurred across sites, but generally the SHMOs established by mature HMO organizations appeared to offer more efficient and effective medical services than newly formed SHMOs.

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PubMed1993

A comparison of S/HMO disenrollees and continuing members.

Four Social/Health Maintenance Organization demonstration projects had disenrollment rates of about 8.6% annually during the first 36 months. This study compares those who disenrolled to those who remained S/HMO members. The analysis found that S/HMOs sponsored by HMOs had lower disenrollment than S/HMOs sponsored by long-term care organizations. The major reasons for disenrollment were dissatisfaction with physician services and premium costs. Having other insurance, not living alone, having inadequate information upon enrollment, having no physical impairments or health problems, and no use of hospital or chronic care were found to be positive predictors of disenrollment. Switching from the S/HMO to another HMO rather than to fee-for-service was associated with having no health problems, having no other health insurance, living alone, and being married.

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PubMed1991

Social health maintenance organizations' service use and costs, 1985-89.

Presented in this article are aggregate utilization and financial data from the four social health maintenance organization (S/HMO) demonstrations that were collected and analyzed as a part of the national evaluation of the S/HMO demonstration project conducted for the Health Care Financing Administration. The S/HMOs, in offering a $6,500 to $12,000 chronic care benefit in addition to the basic HMO benefit package, had higher start up costs and financial losses over the first 5 years than expected, and controlling costs continues to be a challenge to the sites and their sponsors.

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PubMed1988

Factors that contribute to Medicare HMO risk contract success.

In 1985, federal legislation was implemented that allowed HMOs to contract with the Health Care Financing Administration for Medicare enrollees on a risk basis. This change stimulated the development of risk contractors and a growth in HMO Medicare enrollees. This paper examines selected factors that contributed to large Medicare risk contract enrollment in four geographical locations: Los Angeles, Minneapolis-St. Paul, New York City, and Portland, Oregon. The primary types of factors examined were: HMO market conditions, HMO characteristics, and HMO marketing strategies and practices. The market competition varied substantially across the four areas. HMO plan age, total number of HMO enrollees, low premium, and the use of multimedia marketing strategies were positively associated with large Medicare risk contract enrollment.

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PubMed1987

Fiscal conditions and state government policy choices.

Decentralization of public program administration and financing to subnational units of government is examined in the context of hospital and nursing home assistance programs in the United States. Do subnational governments (i.e., states) adapt service utilization controls and tighter program eligibility during periods of fiscal austerity? Are these actions affected by expenditure levels, state budget balances, tax revenues, and the state's proportion of low income persons? Published data covering the period 1978-1982 from each of the 50 U.S. states were analyzed using multiple regression. States with a low proportion of low-income persons and a high per capita tax base were likely to increase minimum income eligibility standards to keep pace with inflation. All other states, regardless of fiscal condition, tended toward more restrictive income standards. States were equally likely to adopt utilization controls for health and long-term care services regardless of state revenue or health expenditures.

Health Policy↗
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.

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