Providing home care services in a for-profit environment.

It is no surprise that politics and ideology will determine the future of home health and long-term care. Those same forces will also dictate whether home care services will become more or less dependent upon federal support. At the moment the prospects are not promising. Over the last several years our national reimbursement policies have pointed toward more and more stringent use of Medicare home health care benefits, despite the assumptions (and the data) that prospective payment systems might legitimately increase their use. The implementation of tight cost limits, consolidation to ten regional fiscal intermediaries, and increased claim denials have signaled home care agencies that cost containment is the aim of the present conservative administration. Private insurance companies, however, have begun to examine the prospects for long-term care and home care policies. Presently, most home care benefits are available through employment-based policies, which, of course, are nearly useless to the elderly, the major users of home care services. But what if businesses provided more comprehensive health care policies so that their employees could have better protection in the case of long-term illnesses? What if the giant corporation such as IBM, Xerox, General Electric, General Motors, and so forth, established programs to underwrite the cost of long-term care? What if private insurance companies attempted to spread the risks among thousands of policy holders so that long-term care insurance premiums were affordable to most older Americans? Rather than new sources of funding, it is more reasonable to expect that the financing of home care services will be reshaped by innovative reimbursement strategies. The future will probably bring prospective, resource-sensitive, or capitated schemes. There are no easy remedies. We must secure the participation of all sectors of our country--both public and private--in a cooperative endeavor. And at the same time we are struggling to reshape the home care financing system, we must continue the effort to reshape the delivery system itself, because the two go hand-in-glove. It is only then that we can begin to allay one of the major deficiencies of our present health care system--the enormous gap in providing and paying for home health care.

Determining the market for Family Nurse Practitioner services: the Seattle experience.

Using a stratified random sample of 239 Seattle residents, a telephone survey was conducted to investigate the relationships between consumer values and consumer intentions to use Family Nurse Practitioner (FNP) services. Applying marketing theories, this study indicated that 27.3% of the respondents intended to use FNP care. Stepwise discriminant analysis suggested that the best predictors of intention to use FNP services were age, family size, compatibility of services with individual and family norms, knowledge about FNPs, and the value attached to health education, which is part of FNP care. Evidence from this study suggests that potential users of FNP services are primarily women, who are relatively more affluent, better-educated, and younger than the general population. Analysis of the characteristics, values, and knowledge of this group provides valuable information for designing effective marketing strategies to reach this target market, meeting the needs of both consumers and providers of care.

Determining the market for nurse practitioner services: the New Haven experience.

This study examined factors associated with the intent to use nurse practitioner (NP) services among 331 residents of the New Haven, Connecticut, urban area. Using a stratified random sample, a telephone survey was conducted to investigate the significance of selected socio-economic, attitudinal, cognitive, and health care use characteristics known to influence consumers' choices about health care providers and services. Applying marketing concepts, these findings indicated that 62% of the respondents would use NP services. Chi-square analysis and stepwise logistic regression indicated that dissatisfaction with present health care, family size, and age were the best predictors of intent to use NP services. Respondents believed that NP services were not different from physician services; they were concerned about issues of availability and cost of care. Consumers would seek NP care if it were covered by health insurance and if it cost less than physician care. Implications for designing effective marketing strategies and policy development are discussed.