The National Health Care Trust Plan: a blueprint for market and long-term care reform.

Abstract

Prologue: Long-term care is one of the forgotten stepchilds of American medicine. Unlike the government-dominated health systems of Canada, the United Kingdom, and other Western industrialized countries, which have integrated long-term care into the range of other offered services, long-term care in the United States is dealt with in a more piecemeal fashion. Complicating the issue is the broader conflict over the respective roles that the private and public sectors should assume over the long term in the American system of care. While the government has resisted addressing the issues of long-term care in any global fashion, total national expenditures for nursing home care have increased many-fold over the last decade. In 1984, nursing home expenditures totaled $32 billion, an increase of 11.1 percent over the previous year. Direct out-of-pocket payments are the source of almost half of total payments to nursing homes, a much higher percentage than for most other medical services. In this essay, William ...