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Care of the Chronically Ill at Home: An Unresolved Dilemma in Health Policy for the United States
Author(s) -
BUHLERWILKERSON KAREN
Publication year - 2007
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/j.1468-0009.2007.00503.x
Subject(s) - dilemma , cornerstone , private insurance , balance (ability) , critically ill , state (computer science) , medicine , health care , nursing , political science , health insurance , public relations , psychology , law , intensive care medicine , art , philosophy , epistemology , algorithm , physical medicine and rehabilitation , computer science , visual arts
The problems of caring for patients with disabling illnesses who neither get well nor die are not new. Such patients have always required assistance at home from family, benevolent volunteers, or paid caregivers. Despite two centuries of experimentation, however, no agreement exists concerning the balance between the public and private resources to be allocated through state funding, private insurance, and family contributions for the daily and routine care at home for chronically ill persons of all ages. This article examines these issues and the unavoidable tensions between fiscal reality and legitimate need. It also uses historical and policy analyses to explain why home care has never become the cornerstone for caring for the chronically ill.