Pricing Long-Term Care for Older Persons.
- 1st ed.
- 1 online resource (374 pages)
Summary report -- Contents -- Foreword -- Acknowledgements -- Executive summary -- 1 Justification for the study -- 1.1 The scope of LTC -- 1.2 The drivers of LTC demand -- 1.3 Why governments should invest in LTC -- 1.4 Why price setting is important -- 2 Organization and financing of LTC -- 2.1 Settings for LTC provision -- 2.2 Organization and financing of LTC -- 2.3 LTC spending -- 3 Determining eligibility for public benefits -- 3.1. Needs assessments -- 3.2. Means-testing -- 3.3. Out-of-pocket costs -- 4 Approaches to setting prices -- 4.1. Base for payment -- 4.2. Unilateral price setting -- 4.3. Collective negotiations -- 4.4. Individual negotiation -- 4.5. Bidding or tendering -- 5 Maintaining a balanced budget, adjustments to prices, and incentives for quality -- 5.1. Maintaining a balanced budget -- 5.2. Price adjustments and add-ons payments -- 5.3. Payment mechanisms and other incentives for quality -- 6 Comparing prices across countries -- 7 Lessons learned for other settings -- References -- Case studies -- Australia -- Abstract -- Introduction -- 1 Interface between health and aged care services -- 1.1 Older people and hospital care -- 1.2 Older people and primary care -- 1.3 End-of-life care -- 2 Aged care services in Australia -- 2.1 Home support -- 2.2 Home care -- 2.3 Residential aged care -- 2.4 Support for carers and respite care -- 2.5 Transition care -- 2.6 Short-term restorative care -- 3 Consumers and providers of aged care -- 3.1 Consumer access and eligibility -- 3.2 Provider approval and quality standards -- 3.3 Characteristics of purchasers and providers -- 3.4 Planning and control of supply -- 4 Structure of payments and pricing for aged care services -- 4.1 Home support payments and pricing -- 4.2 Home care payments and pricing -- 4.3 Residential aged care payments and pricing. 5 Challenges for the Australian aged care system -- 5.1 Assessment process -- 5.2 Allocation of residential aged care places -- 5.3 Staffing adequacy and pricing -- 6 Lessons from the Australian aged care system -- 6.1 Designing services that better reflect consumer wishes and improve fiscal sustainability -- 6.2 Household wealth and the sustainability of aged care financing -- 6.3 Market mechanisms, quality and price -- References -- France -- Abstract -- Glossary -- 1 Introduction -- 2 Major providers of LTC services -- 2.1 Skilled nursing facilities -- 2.2. Residential care facilities -- 2.2.1 Medical residential facilities -- 2.2.2 Non-medical residential care facilities -- 2.3. LTC services at home -- 2.4 Palliative care -- 3 Funding and management -- 3.1 Financing medical LTC -- 3.1.1 Long-term illness exemption scheme -- 3.1.2 The role of CNSA -- 3.1.3 The role of ARS -- 3.2 Funding of personal care and assistance services -- 3.2.1 APA at home -- 3.2.2 APA in nursing homes -- 3.2.3 Others social cash benefits for LTC -- 3.3 Pension funds -- 3.4 Central government tax benefits -- 3.5 Out-of-pocket payments -- 4 Base for payment -- 5 Price setting -- 5.1 Price setting for skilled nursing facilities -- 5.2 Price setting for residential care facilities -- 5.2.1 Residential nursing homes -- The medical care package -- The dependency bundle -- Accommodation fee -- 5.2.2 Social residence -- 5.3 Price setting for LTC services at home -- 5.3.1 Self-employed nurses -- From fee-for-service to per-day fee -- 5.3.2 Home-care nursing services (SSIAD) -- 5.3.3 Personal care and assistance at home -- Price setting for SAAD -- Prices for Self-employed domestic help -- Prices for day care centres -- 5.4 Price setting for palliative care -- 6 Issues and evaluation -- 6.1 Cost and accessibility of LTC -- 6.2 Coordination of LTC services -- 6.3 Care quality. 6.4 Evaluation of recent reforms -- Conclusion -- References -- Germany -- Abstract -- Table of Contents -- 1 The context -- Life expectancy increases, but at a slower pace than the OECD average -- Germany's population is projected to age and to decrease -- 2 Long-term care insurance -- Germany introduced the LTCI as a "fifth pillar "of the social security system in 1995 -- Employers and employees contribute to the social LTCI with a share of their salary -- The rate of beneficiaries has increased over the past three decades -- An ageing population and the expansion in beneficiaries and benefits lead to increasing expenditures -- 3 Beneficiaries at a glance -- Four out of five beneficiaries receive home care -- 3.1 Eligibility for LTCI benefits -- 3.2 Entitlements for LTCI benefits -- The system favours home care over residential care -- Most beneficiaries opt for cash benefits for home care, but expenditures are highest for residential -- Benefits have been expanded since 1995, most notably in 2015/2017 -- 4 Providers of home and residential care -- 4.1 Home care providers -- 4.2 Residential care providers -- 4.3 LTC workforce in home and residential care -- 5 Choice and service pricing -- 5.1 Price-setting in home care -- Co-payment rates are unclear in LTC -- 5.2 Price-setting in residential care -- Co-payments of beneficiaries have increased over the past decades -- References -- Japan -- Abstract -- Table of Contents -- Introduction -- 1 Development of health services -- 1.1 Historical background -- 1.2 Regulating the number and function of hospital beds -- 2 Development of social services -- 3 LTCI -- 3.1 Basic design -- 3.2 Development of LTCI -- 4 Health Insurance Fee Schedule -- 4.1 Basic structure -- 4.2 Revision process -- 4.3 Outpatient care and home care -- 4.4 Inpatient care -- 5 LTCI Fee Schedule -- 5.1 Basic structure. 5.2 Revisions: process and impact -- 6 Challenges in SHI and LTCI -- 7 Lessons for other countries -- References -- Republic of Korea -- Abstract -- Table of Contents -- 1 Population coverage of LTCI -- 2 Benefits and expenditures of LTCI -- 3 LTC provision -- 4 Payment and price setting in LTCI -- 5 Coordination between NHI and LTCI -- References -- Appendix LTCI beneficiaries by service type, 2012-2018, Republic of Korea -- Netherlands -- Abstract -- Table of Contents -- 1 Introduction -- 2 Background on the Dutch long-term care system -- 2.1 Historical perspective and recent reforms -- 2.2 Main features of current long-term care financing -- 2.2.1 Long-term Care Act -- 2.2.2. Health Insurance Act -- 2.2.3. Social Support Act -- 2.3 Incentives for ensuring financial sustainability -- Cost shifting -- Coordination problems -- Efficiency problems -- 3 Price Setting -- 3.1 Social long-term care insurance -- 3.1.1 The regional budget -- 3.1.2 Maximum prices -- 3.1.3 The demand for care -- 3.1.4 Contract negotiations -- 3.1.5 Conclusion -- 3.2 Social health insurance -- 3.2.1 The overall budget constraint -- 3.2.2 Maximum prices and freely negotiable prices -- Regulated maximum prices -- Freely negotiable prices -- 3.2.3 Budget ceilings, renegotiations and waiting times -- 3.2.4 Non-contracted care -- 3.2.5 Quality and other performance targets -- 3.2.6 Towards case-mix adjusted monthly payments per patient -- 3.3 Social Support Act -- 3.3.1 Boundaries for contract negotiations -- 3.3.2 Contract negotiations -- 3.3.3 Conclusion -- 4 Conclusion -- 4.1 Key characteristics of the Dutch system -- 4.2 Best practices -- Equitable access -- Integrated pricing -- 4.3 Challenges -- Appropriate incentives and tools for procurement of care within each financing scheme -- Lack of incentives and tools to coordinate care across financing schemes. Paying for quality and efficiency -- References -- Spain -- Abstract -- Table of Contents -- Glossary and abbreviations -- 1 Overview of the context, objective and actual use of prices to pay providers of care for older per -- 2 Providers of care for older persons -- 2.1 Definition, scope and components: hospitals, skilled nursing facilities, home and residential ca -- 2.2 Link to Universal Health Coverage entitlements -- 3 Financing and systems issues -- 3.1 Care coordination -- 3.2 Source of financing -- 3.3 Characteristics of purchasers and providers -- 3.4 Criteria for eligibility to care: entitlement, means-testing, characteristics of the individual -- 4 Base for payment by facility -- 4.1 Primary care -- 4.2 Outpatient services -- 4.3 Hospitals -- 4.4 Skilled nursing facilities -- 4.5 Residential facilities -- 4.6 Home-based care (health and social) -- 4.7 Day care -- 4.8 Hospice -- 5 Informal care linked to cash transfers to families for dependants -- 6 Process by which prices are determined (for the categories of facilities) -- 6.1 Unilateral administrative price setting -- 7 Technical process of price setting (for the categories of facilities) -- 7.1 Process of data collection from providers -- 7.2 Costing methods -- 7.3 From cost submission to price setting -- 8 Methods of adjustments -- 8.1 For health needs/beneficiary characteristics -- 8.2 Access, financial protection and quality -- 9 Mean price for base for payment by provider (in national currencies) -- 10 Infrastructure for costing and pricing -- 10.1 Institutional entities (to what extent existing bodies cover different aspects of care for olde -- 10.2 Stakeholder consultation -- 10.3 Information disclosure (prices and quality) -- 11 Review evidence on the effects of price setting and price regulation on stated objectives. 12 Best practices for other countries, in particular middle- and low-income countries.
9789240033771
Electronic books.
Summary report -- Contents -- Foreword -- Acknowledgements -- Executive summary -- 1 Justification for the study -- 1.1 The scope of LTC -- 1.2 The drivers of LTC demand -- 1.3 Why governments should invest in LTC -- 1.4 Why price setting is important -- 2 Organization and financing of LTC -- 2.1 Settings for LTC provision -- 2.2 Organization and financing of LTC -- 2.3 LTC spending -- 3 Determining eligibility for public benefits -- 3.1. Needs assessments -- 3.2. Means-testing -- 3.3. Out-of-pocket costs -- 4 Approaches to setting prices -- 4.1. Base for payment -- 4.2. Unilateral price setting -- 4.3. Collective negotiations -- 4.4. Individual negotiation -- 4.5. Bidding or tendering -- 5 Maintaining a balanced budget, adjustments to prices, and incentives for quality -- 5.1. Maintaining a balanced budget -- 5.2. Price adjustments and add-ons payments -- 5.3. Payment mechanisms and other incentives for quality -- 6 Comparing prices across countries -- 7 Lessons learned for other settings -- References -- Case studies -- Australia -- Abstract -- Introduction -- 1 Interface between health and aged care services -- 1.1 Older people and hospital care -- 1.2 Older people and primary care -- 1.3 End-of-life care -- 2 Aged care services in Australia -- 2.1 Home support -- 2.2 Home care -- 2.3 Residential aged care -- 2.4 Support for carers and respite care -- 2.5 Transition care -- 2.6 Short-term restorative care -- 3 Consumers and providers of aged care -- 3.1 Consumer access and eligibility -- 3.2 Provider approval and quality standards -- 3.3 Characteristics of purchasers and providers -- 3.4 Planning and control of supply -- 4 Structure of payments and pricing for aged care services -- 4.1 Home support payments and pricing -- 4.2 Home care payments and pricing -- 4.3 Residential aged care payments and pricing. 5 Challenges for the Australian aged care system -- 5.1 Assessment process -- 5.2 Allocation of residential aged care places -- 5.3 Staffing adequacy and pricing -- 6 Lessons from the Australian aged care system -- 6.1 Designing services that better reflect consumer wishes and improve fiscal sustainability -- 6.2 Household wealth and the sustainability of aged care financing -- 6.3 Market mechanisms, quality and price -- References -- France -- Abstract -- Glossary -- 1 Introduction -- 2 Major providers of LTC services -- 2.1 Skilled nursing facilities -- 2.2. Residential care facilities -- 2.2.1 Medical residential facilities -- 2.2.2 Non-medical residential care facilities -- 2.3. LTC services at home -- 2.4 Palliative care -- 3 Funding and management -- 3.1 Financing medical LTC -- 3.1.1 Long-term illness exemption scheme -- 3.1.2 The role of CNSA -- 3.1.3 The role of ARS -- 3.2 Funding of personal care and assistance services -- 3.2.1 APA at home -- 3.2.2 APA in nursing homes -- 3.2.3 Others social cash benefits for LTC -- 3.3 Pension funds -- 3.4 Central government tax benefits -- 3.5 Out-of-pocket payments -- 4 Base for payment -- 5 Price setting -- 5.1 Price setting for skilled nursing facilities -- 5.2 Price setting for residential care facilities -- 5.2.1 Residential nursing homes -- The medical care package -- The dependency bundle -- Accommodation fee -- 5.2.2 Social residence -- 5.3 Price setting for LTC services at home -- 5.3.1 Self-employed nurses -- From fee-for-service to per-day fee -- 5.3.2 Home-care nursing services (SSIAD) -- 5.3.3 Personal care and assistance at home -- Price setting for SAAD -- Prices for Self-employed domestic help -- Prices for day care centres -- 5.4 Price setting for palliative care -- 6 Issues and evaluation -- 6.1 Cost and accessibility of LTC -- 6.2 Coordination of LTC services -- 6.3 Care quality. 6.4 Evaluation of recent reforms -- Conclusion -- References -- Germany -- Abstract -- Table of Contents -- 1 The context -- Life expectancy increases, but at a slower pace than the OECD average -- Germany's population is projected to age and to decrease -- 2 Long-term care insurance -- Germany introduced the LTCI as a "fifth pillar "of the social security system in 1995 -- Employers and employees contribute to the social LTCI with a share of their salary -- The rate of beneficiaries has increased over the past three decades -- An ageing population and the expansion in beneficiaries and benefits lead to increasing expenditures -- 3 Beneficiaries at a glance -- Four out of five beneficiaries receive home care -- 3.1 Eligibility for LTCI benefits -- 3.2 Entitlements for LTCI benefits -- The system favours home care over residential care -- Most beneficiaries opt for cash benefits for home care, but expenditures are highest for residential -- Benefits have been expanded since 1995, most notably in 2015/2017 -- 4 Providers of home and residential care -- 4.1 Home care providers -- 4.2 Residential care providers -- 4.3 LTC workforce in home and residential care -- 5 Choice and service pricing -- 5.1 Price-setting in home care -- Co-payment rates are unclear in LTC -- 5.2 Price-setting in residential care -- Co-payments of beneficiaries have increased over the past decades -- References -- Japan -- Abstract -- Table of Contents -- Introduction -- 1 Development of health services -- 1.1 Historical background -- 1.2 Regulating the number and function of hospital beds -- 2 Development of social services -- 3 LTCI -- 3.1 Basic design -- 3.2 Development of LTCI -- 4 Health Insurance Fee Schedule -- 4.1 Basic structure -- 4.2 Revision process -- 4.3 Outpatient care and home care -- 4.4 Inpatient care -- 5 LTCI Fee Schedule -- 5.1 Basic structure. 5.2 Revisions: process and impact -- 6 Challenges in SHI and LTCI -- 7 Lessons for other countries -- References -- Republic of Korea -- Abstract -- Table of Contents -- 1 Population coverage of LTCI -- 2 Benefits and expenditures of LTCI -- 3 LTC provision -- 4 Payment and price setting in LTCI -- 5 Coordination between NHI and LTCI -- References -- Appendix LTCI beneficiaries by service type, 2012-2018, Republic of Korea -- Netherlands -- Abstract -- Table of Contents -- 1 Introduction -- 2 Background on the Dutch long-term care system -- 2.1 Historical perspective and recent reforms -- 2.2 Main features of current long-term care financing -- 2.2.1 Long-term Care Act -- 2.2.2. Health Insurance Act -- 2.2.3. Social Support Act -- 2.3 Incentives for ensuring financial sustainability -- Cost shifting -- Coordination problems -- Efficiency problems -- 3 Price Setting -- 3.1 Social long-term care insurance -- 3.1.1 The regional budget -- 3.1.2 Maximum prices -- 3.1.3 The demand for care -- 3.1.4 Contract negotiations -- 3.1.5 Conclusion -- 3.2 Social health insurance -- 3.2.1 The overall budget constraint -- 3.2.2 Maximum prices and freely negotiable prices -- Regulated maximum prices -- Freely negotiable prices -- 3.2.3 Budget ceilings, renegotiations and waiting times -- 3.2.4 Non-contracted care -- 3.2.5 Quality and other performance targets -- 3.2.6 Towards case-mix adjusted monthly payments per patient -- 3.3 Social Support Act -- 3.3.1 Boundaries for contract negotiations -- 3.3.2 Contract negotiations -- 3.3.3 Conclusion -- 4 Conclusion -- 4.1 Key characteristics of the Dutch system -- 4.2 Best practices -- Equitable access -- Integrated pricing -- 4.3 Challenges -- Appropriate incentives and tools for procurement of care within each financing scheme -- Lack of incentives and tools to coordinate care across financing schemes. Paying for quality and efficiency -- References -- Spain -- Abstract -- Table of Contents -- Glossary and abbreviations -- 1 Overview of the context, objective and actual use of prices to pay providers of care for older per -- 2 Providers of care for older persons -- 2.1 Definition, scope and components: hospitals, skilled nursing facilities, home and residential ca -- 2.2 Link to Universal Health Coverage entitlements -- 3 Financing and systems issues -- 3.1 Care coordination -- 3.2 Source of financing -- 3.3 Characteristics of purchasers and providers -- 3.4 Criteria for eligibility to care: entitlement, means-testing, characteristics of the individual -- 4 Base for payment by facility -- 4.1 Primary care -- 4.2 Outpatient services -- 4.3 Hospitals -- 4.4 Skilled nursing facilities -- 4.5 Residential facilities -- 4.6 Home-based care (health and social) -- 4.7 Day care -- 4.8 Hospice -- 5 Informal care linked to cash transfers to families for dependants -- 6 Process by which prices are determined (for the categories of facilities) -- 6.1 Unilateral administrative price setting -- 7 Technical process of price setting (for the categories of facilities) -- 7.1 Process of data collection from providers -- 7.2 Costing methods -- 7.3 From cost submission to price setting -- 8 Methods of adjustments -- 8.1 For health needs/beneficiary characteristics -- 8.2 Access, financial protection and quality -- 9 Mean price for base for payment by provider (in national currencies) -- 10 Infrastructure for costing and pricing -- 10.1 Institutional entities (to what extent existing bodies cover different aspects of care for olde -- 10.2 Stakeholder consultation -- 10.3 Information disclosure (prices and quality) -- 11 Review evidence on the effects of price setting and price regulation on stated objectives. 12 Best practices for other countries, in particular middle- and low-income countries.
9789240033771
Electronic books.