This book examines the implementation of the prospective payment system (PPS) in the US for Medicare hospital reimbursement, which started in 1983.
The authors discuss the impact of the PPS on health care provision and conclude that rather than improving conditions for the elderly in their transition from hospital to community and decreasing escalating health costs, the PPS has restructured the system with the result that the greater financial burden is placed on informal caregivers, community and home health care agencies and the elderly themselves.
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About the Author
Carroll L. Estes is Professor of Sociology at the University of California, San Francisco. She is the founding and former director of the Institute for Health & Aging (1979-98) and the former Chair of the Department of Social & Behavioral Sciences, School of Nursing, UCSF. Dr. Estes is a member of the Institute of Medicine and the National Academy of Sciences and past president of the Gerontological Society of America, American Society on Aging, and Association for Gerontology in Higher Education. She has served as consultant to the U.S. Commissioner of Social Security and the U.S. Senate and House committees on aging for more than two decades. Her career and theoretical perspective were firmly established with the publication of The Aging Enterprise (Jossey Bass, 1979), which became an instant classic in the field of aging research. She subsequently published two books with Sage: The Long Term Care Crisis (1993) and Social Policy and Aging (2001). In 2001, she received the Distinguished Scholars Award from the American Sociological Association Section on Aging and the Life Course (a sort of life-time achievement award) and has received other major awards such as The Distinguished Scholarship Award of the Pacific Sociological Association (1989), The Donald Kent Award of the Gerontological Society of America (1992), and The Beverly Award of the Association for Gerontology in Higher Education (1993). The original version of the proposed book has been credited as the foundation of her work in the citations for each of these awards, and her work is nationally and internationally recognized.
Table of Contents
IntroductionPART ONE: OVERVIEWProspective Payment Revolution and Long Term CareRestructuring of the Nonprofit SectorPART TWO: FROM HOSPITAL TO COMMUNITYDischarge Planners as Gatekeepers to Community CareDoes Out of the Hospital Mean Out of Luck?Service ParadoxPART THREE: HOME HEALTH AND NURSING HOME CAREMetamorphosis of Home Health CareNursing Homes Under Prospective PaymentAccess to Nursing Home and Home Health ServicesPART FOUR: ELDER CARE AND THE COMMUNITYInformalization and Community CareAccess in PerilCommunity Variation in Policy ImplementationWaves of ChangePART FIVE: THE FUTUREPolicy Elites and Fiscal CrisisEmpowerment ImperativeNo-Care Zone and Social Policy