Known, Unknown, and Unknowable Uncertainties

In normative decision theory, the weight of an uncertain event in a decision is governed solely by the probability of the event. A large body of empirical research suggests that a single notion of probability does not accurately capture peoples' reactions to uncertainty. As early as the 1920s, Knight made the distinction between cases where probabilities are known and where probabilities are unknown. We distinguish another case –- the unknowable uncertainty –- where the missing information is unavailable to all. We propose that missing information influences the attractiveness of a bet contingent upon an uncertain event, especially when the information is available to someone else. We demonstrate that the unknowable uncertainty –- falls in preference somewhere in between the known and the known uncertainty.     

老年人在医保改革中面临的风险与对策

1999年,我国社会已进入老年型社会,其中一个重要问题是建立健全老年人医疗保障(以下简称医保)制度以有效保证老年人口的健康.我国在上世纪50年代确立的劳保医疗与公费医疗制度中明确规定,干部工人离休、退休、退职以后享受公费医疗待遇,1978年国务院重申了这一政策;1980年代以来的历次医改也都给予老年群体的医保以特别关注.     

Older Adults Navigating Medicare: When Benefits Are Denied

Guided by Bourdieu's theory of practice and symbolic violence, this qualitative study explored experiences and perceptions of elderly beneficiaries who had been denied rehabilitation services by Medicare. In semistructured interviews, 12 beneficiaries or family members told of the physical, psychological, and financial consequences of service denial/termination. The resulting perception of Medicare was as a cumbersome, difficult to negotiate system. Findings have implications for future research on service denial and indicate the need for better communication with, and support of, consumers by health care professionals when this occurs.     

Moving Toward Medicare Home Health Coverage for Persons with Alzheimer's Disease

ABSTRACT

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

Moving toward Medicare home health coverage for persons with Alzheimer's disease

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

浅析奥巴马政府的医疗改革政策及其对中国的启示

针对美国医疗领域长期存在的医疗费用快速上涨、医疗保险制度性障碍和医疗服务质量等问题,奥巴马政府提出了以控制医疗费用、扩大医疗保险覆盖面、提高医疗服务质量为主要内容的医疗改革方案,意在实现"向全美国民众提供可承受的、可进入性的医疗保健"之目标。相关法案虽然几经修改,但最终在美国国会众、参两院获得微弱通过,并在日前由奥巴马总统签署。尽管其效果目前还无法判断,但方案本身在一定程度上已经能够为我国的医疗改革提供一些启示。     

Integrating Mental Health Parity for Homebound Older Adults Under the Medicare Home Health Care Benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.     

After the tax revolt: Why Medicare matters more to middle Australia than lower taxes

The Australian Survey of Social Attitudes 2003 gives new insights into the public's increasing preference for more social spending and their willingness to pay more taxes to fund services. This paper profiles the new electorate and discusses factors driving this trend in public opinion. Multivariate analysis allows us to identify the key demographic, political and policy variables that predict support for spending. All the usual factors matter: being older and more educated, and identifying as Labor, Green or Democrat all predict support for higher spending. But we find that policy perceptions matter as well: believing that health and Medicare and/or public education have declined in the past two years brings major support for increased spending. We also find that the Australian public supports modest tax increases to fund spending on health and education and that the Australian electorate is more open minded about tax rises than conventional wisdom holds. Our main conclusions are that support for social spending over reduced taxes has increased over the past two decades, and especially after the election of the Howard Government, and that dissatisfaction with health and Medicare, and public education, are reshaping the fiscal preferences of the Australian electorate.     

The Medicare Part D Coverage Gap: Implications for Non-Dually Eligible Older Adults With a Mental Illness

This study examines how the Medicare Part D coverage gap impacts non-dually eligible older adults with a mental illness. Qualitative, semistructured interviews were conducted with 11 case managers from community-based agencies serving persons, age 55 and over, with a mental disorder. Five themes illustrating the central difficulties associated with the Part D gap emerged: medication affordability, beneficiary understanding, administrative barriers, Low-Income Subsidy income and asset guidelines, and medication compliance. Although the Patient Protection and Affordable Care Act gradually reduces cost sharing within the gap, findings suggest that medication access and adherence may continue to be impacted by the benefit's structure.     

Racial/Ethnic Disparities in Access to Medicare Home Health Care: The Disparate Impact of Policy

The Balanced Budget Act of 1997 dramatically decreased reimbursements for traditional Medicare home health patients. A multivariate analysis of Medicare Current Beneficiary Survey data showed that African American and “other” users experienced greater decreases in home care between 1996 and 1998 than did White users. These results suggest (a) race/ethnicity is an independent factor in determining service use post-BBA and (b) health policy has a disparate impact on minority older adults. Capitated payment systems must be pursued cautiously to avoid negative effects on vulnerable populations. The potential for current and future Medicare policy changes to negatively affect vulnerable populations is also discussed.