Health affairs
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In 2008, U. S. health care spending growth slowed to 4.4 percent--the slowest rate of growth over the past forty-eight years. ⋯ These developments reflect the general pattern that larger increases in the health spending share of GDP generally occur during or just after periods of economic recession. Despite the overall slowdown in national health spending growth, increases in this spending continue to outpace growth in the resources available to pay for it.
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Health foundations have invested in services, research, and advocacy to improve the financing and delivery of long-term services and supports. This article describes some of the broad array of approaches they have taken--in such areas as aging in place, assisted living, "culture change" in nursing homes, quality improvement, augmenting the workforce, and paying for care.
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Almost one-fourth of Medicare beneficiaries discharged from the hospital to a skilled nursing facility were readmitted to the hospital within thirty days; this cost Medicare $4.34 billion in 2006. Especially in an elderly population, cycling into and out of hospitals can be emotionally upsetting and can increase the likelihood of medical errors related to care coordination. Payment incentives in Medicare do not encourage providers to coordinate beneficiaries' care. Revising these incentives could achieve major savings for providers and improved quality of life for beneficiaries.
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Medicare and Medicaid, two publicly funded health programs, both cover populations in need of long-term care, but they are poorly coordinated. Gaps often exist in some services while there is overlap in others. ⋯ Although growing numbers of people receive home and community-based services paid for by the two programs, there are wide variations across states and among target groups. The system of long-term care is in need of structural reform.
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Many elderly people spend their final days in nursing homes. For them, high-quality end-of-life care is an important component of their overall care. ⋯ We recommend creating a separate end-of-life Medicare benefit for nursing home residents based on documented need for services that neither requires physicians to certify a person's prognosis, nor requires beneficiaries to choose it or to agree to forgo curative care. Nursing homes would be paid directly for end-of-life care services and held accountable for their quality.