In-home health services in California: some lessons for national health insurance

Abstract

Spiralling Medicare and Medicaid expenditures, recent revelations about unhealthy conditions in nursing homes, and pressure for national health insurance have led to increased interest in in-home health services as appropriate and cost-effective. Medicare and Medicaid provided some stimulus for development of in-home health services. Shortly after these programs went into effect, however, major policy decisions were made aimed at curbing utilization of in-home health services. California home health data for 1966-1973 document the effects of major policies that led to the development and decline of in-home health services under Medicare and Medicaid. A review of those policies, supported by the California data, indicate that in-home health services have been greatly restricted by historical underdevelopment and legislative and regulatory emphases. In addition, the study indicates the limitations of the kind of data currently collected and suggests data requirements necessary for future program evaluation and planning in home health.