Is the self of the infant preserved in the adult?

Medicine, Health Care and Philosophy - What does a confrontation between philosophy and psychoanalysis look like? My task is a philosophical investigation of a psychoanalytic concept. Thus, I offer...     

Is the future in the cards?

Smart cards have yet to catch on in health care. Applications for data security and marketing, however, could boost their use.     

Is German long-term care insurance a model for the United States?

German long-term care insurance, implemented in 1995, significantly extends the coverage of care-related risks. Given the similarities of German and U.S. institutional features, the German social insurance approach has been put forward as a possible model for long-term care in the United States. Using a political economy framework, the authors conducted a policy analysis that compares the main shortfalls of long-term care (LTC) provision in the United States and Germany, examines the responses provided by LTC insurance in Germany, and relates them to broader trends and proposals for change in welfare policy in both countries. German LTC insurance includes a high degree of consumer direction and compensation and protection for informal caregivers; it supports the extension of community-based services. Its shortfalls include the continued split between health and LTC insurance. In both countries, decentralization and institutional and financial fragmentation are some of the characteristics responsible for the failure to promote egalitarian social policy and substantially expand social protection to family- and care-related risks. The German LTC program is a good model for the United States. With a social insurance approach to LTC, costs are spread across the largest possible risk pool. Major goals that can be reached with such a program include establishment of universal entitlements to LTC benefits, consumer choice, and equitability and uniformity.     

How much insurance is enough? What to look for in a long term care insurance policy

LTC insurance is a valuable financial tool to help pay for pending LTC. However, LTC insurance is not for everyone. For those who could benefit from a policy, questions arise as to how much to buy and what consumer options to purchase in a policy. Insurance is most appropriate for couples with assets of $110,000 or more, excluding their house, car, and personal belongings. Single persons with a need to protect assets should have at least $40,000 in assets. These individuals have smaller need for LTC insurance to protect assets for their children. How much insurance to buy depends on the cost of LTC and the financial resources of the person. Premiums for LTC insurance are level. A company cannot raise the premiums for an individual, but may request an increase for a class of people. With the potential that premiums may increase and that buying power of income may decline, the policy should be affordable both at time of purchase and in future. Policies pay a specified benefit amount for a specified benefit period. In deciding how much insurance to buy, it is advisable to buy a higher benefit amount for a shorter benefit period. This provides the greatest likelihood of receiving the policy's maximum benefit. The deductible amount should be between 20 and 100 days. In selecting a policy, the most important criterion is the company itself.(ABSTRACT TRUNCATED AT 250 WORDS)     

Means-tested public support and the interaction between long-term care insurance and informal care

This paper investigates theoretically how the structure of means-tested public long-term care (LTC) support influences the relationship between LTC insurance and informal care. Three types of public support encountered in various means-tested LTC schemes are examined. First, the level to be considered for means-testing only takes into account the level of wealth of the recipient without considering the cost of LTC or the possible insurance benefits. Second, the public support also considers the LTC needs of the recipient. Third, the means-test structure takes into consideration insurance benefits as well. Our results show that the optimal levels of insurance and informal care as well as their relationship are strongly influenced by the ways means-tested public support for LTC is structured, which have important implications in terms of public policy for the financing of LTC needs.     

Disability benefits as an incentive for hysterectomy: Uterine fibroid patients in Taiwan

Worker compensation insurance in Taiwan ensures that a woman under the age of 45 years who has her uterus removed can receive disability compensation benefits. The present study investigated whether such a compensation policy was related to a woman’s inclination to have a hysterectomy. We extracted the records of 16,030 women diagnosed with uterine fibroids (UF) between 2000 and 2010 from the Longitudinal Taiwan Health Insurance Database. Each younger and older age group had a significantly lower hysterectomy rate compared to that of the 44-year-old age group. Moreover, significantly more patients with lower monthly wages had had hysterectomies than those with higher monthly wages. Policy makers should be aware that worker compensation regulations in Taiwan might encourage women with economic need to undergo hysterectomy surgery when approaching the age of 45 years.     

China: Facing a long-term care challenge on an unprecedented scale

Population ageing is occurring in China at a breathtaking pace and rapidly becoming a major public health issue. Due to the one-child policy, rural/urban migration and other societal changes, the family-dependent long-term care (LTC) of the past will no longer suffice. Barely existent now, both institutional and community-based services will need to expand to meet the growing need. China is still at an earlier stage in economic development and will be challenged to build these services and train staff. Furthermore, many elders are not yet covered by financial and insurance support. This massive demographic transition requires political efforts to develop integrated and sustainable national LTC systems.     

Germany's long-term care insurance model: lessons for the United States

The implementation of public long term care (LTC) insurance in 1995 in Germany is an important public policy development that offers lessons for the U.S. The German LTC model is comprehensive and mandatory, covering 88 percent of its population, by equal premium contributions on wages from employees and employers. The new German system has uniform eligibility and benefit criteria, covers both institutional and home care, pays for family caregivers, is financially solvent, and is considered a success by the public. In contrast, the U.S. financing of LTC is largely private, with the government serving as the safety net for the majority of the LTC costs after individuals spend down their resources. This paper considers whether a German-type LTC system is feasible and affordable and discusses the issues and complexities of public LTC insurance, including cost containment, home care services, quality control, and administrative structure.     

China's policy experimentation on long‐term care insurance: Implications for access

China's population is aging rapidly, while the traditional long‐term care (LTC) system that heavily relies on families is eroding. In response, China has embarked on a journey of policy experimentation for long‐term care insurance (LTCI) since 2016, launching LTCI pilots in 15 pioneer cities. These pilots have a great diversity in participation, eligibility, and provision. This paper estimates the prevalence of LTC needs and analyzes the impact of the LTCI pilots on access. Although substantial progress has been achieved, the overall coverage of LTCI is still relatively small, and a large proportion of vulnerable people needing LTC seem to be left behind because of the strict eligibility criteria. This analysis suggests that future policy experimentation on LTCI reform in China needs to address the following pressing policy issues: expanding the coverage of LTCI; narrowing rural–urban disparities in access; improving access for vulnerable subpopulations; and reducing the heavy reliance on institutional care.     

中国台湾地区创新医疗技术支付进展及经验

从中国台湾地区二代全民健康保险制度、“卫生福利部健康保险署”对新医疗服务项目的管理流程、全民健康保险按疾病诊断相关分组支付制度下的新增全新功能类别医疗技术因应方案三方面,介绍了中国台湾地区全民健康保险对创新医疗技术支付的做法和经验。在此基础上为我国创新医疗技术支付政策改革提供参考和借鉴,包括构建多渠道的筹资体系、引入第三方评估机制、推进疾病诊断相关分组付费制度下的医疗保险支付改革。     

Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings

In response to a rising concern for multidrug resistance and Clostridium difficile infections, the Centers for Medicare and Medicaid services (CMS) will require all long-term care (LTC) facilities to establish an antibiotic stewardship program by November 2017. Thus far, limited evidence describes implementation of antibiotic stewardship in LTC facilities, mostly in academic- or hospital-affiliated settings. To support compliance with CMS requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at AMDA—The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the LTC setting. The intent of this policy, which can be adapted by individual facilities, is to help LTC facilities implement an antibiotic stewardship policy that will meet or exceed CMS requirements. We also briefly discuss implementation of an antibiotic stewardship program in LTC settings, including a list of free resources to support those efforts.     

Labor supply effects of long‐term care reform in Germany

Many informal caregivers are of working age, facing the double burden of providing care and working. Negative labor supply effects can severely reduce the comparative cost advantage of informal over formal care arrangements. When designing long‐term care (LTC) policies, it is crucial to understand the effects not only on health outcomes but also on labor supply behavior of informal caregivers. We evaluate labor supply reactions to the introduction of the German long‐term care insurance in 1995 using a difference‐in‐differences approach. The long‐term care insurance changes the caregivers' trade‐off between labor supply and care provision. The aim of the reform was to strengthen informal care arrangements. We find a strong negative labor supply effect for men but not for women. We argue that the LTC benefits increased incentives for older men to leave the labor market. The results reveal a trade‐off for policy makers that is important for future reforms—in particular for countries that mainly base their LTC system on informal care.