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Hospital care with all the comforts of home.

It remains to be seen whether President Clinton can curtail the spiraling cost of health care. Whatever the final plan, increased attention to one important link in the health care chain can most certainly have an impact on cost. That link is home health care, which is rapidly increasing in popularity with patients and providers alike.

Providing hospital-quality care at home is nothing new. Pioneer work begun more than 30 years ago at The Boston Dispensary, a teaching hospital of the Tufts University School of Medicine, clearly demonstrated the advantages of home health care. Chronically ill patients who normally would have required long-term hospital care were successfully treated at home by a team of staff physicians, visiting nurses, social workers, and medical students. Not only did the cost of their care drop markedly, but the patients were much happier at home.

An essential element of home care is the education of family members, as well as the patient. People with the most severe disabilities (such as polio patients in "iron lungs" decades ago and kidney dialysis patients in more recent years) have received home treatment for years. Patients and family members can learn sophisticated medical procedures, and visiting nurses and homemaker services can fill the gap when no family is present.

Most employer-provided insurance plans cover some form of home health care services. The care covered, however, varies widely. Medicare also provides coverage such as skilled nursing services, home health aides, and many other kinds of care, all of which are detailed in the Medicare handbook, which is updated annually.

Physicians or the hospital where the patient has been treated in most instances must direct insurance and/or Medicare to cover services. Families need to consult with all parties concerned before ordering such necessities as homemaker services (cooking, cleaning, etc.) that may not be covered. It is also important that families determine whether any home care agencies under consideration are certified by proper authorities. Many are not, and many providers will not cover services of uncertified agencies.

Obtaining home care services and reimbursement for them may be a time-consuming process, as is educating family members who will be involved in the care. The rewards to patients and families are considerable, however, and the ultimate effect on the nation's health care costs can be dramatic.
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Title Annotation:health care reform
Publication:Medical Update
Date:Aug 1, 1993
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