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The Gerontologist 41:474-480 (2001)
© 2001 The Gerontological Society of America

Home- and Community-Based Long-Term Care

Lessons From Denmark

Mary Stuart, ScDa and Michael Weinrich, MDb

a Department of Sociology and Anthropology, University of Maryland Baltimore County
b National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development, Bethesda, Maryland

Correspondence: Mary Stuart, ScD, Department of Sociology and Anthropology, University of Maryland, 1000 Hilltop Circle, Baltimore, MD 21250. E-mail: stuart{at}umbc.edu.

Decision Editor: Laurence G. Branch, PhD

Purpose: Denmark is cited as a model in the development of home- and community-based systems for the frail elderly population. We examined the results of this natural experiment and considered implications for U.S. policy. Design and Methods: We used international comparative policy analysis, including site visits and semistructured interviews with Danish leadership in conjunction with a review of published literature, reports, and administrative data from Denmark and the United States. Results: After 12 years of implementing integrated systems for home- and community-based services in 275 municipalities, growth in Danish long-term care expenditures has leveled off; expenditures appear to be decreasing for the over-80 population and have dropped as a percentage of the gross domestic product. Access to and quality of long-term care services appear to remain generally satisfactory. During this period, comparable expenditures in the United States have increased, and deficits in access and quality persist. Implications: These findings should be of interest to state and federal policy makers considering strategies to reduce the rate of growth in Medicaid and Medicare expenditures for elders and to expand home- and community-based services.

Key Words: Long-term care • Medicaid • Medicare




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