Strategic Pathways
Research on Shanghai Integrated Health Care Practical Experience: An Analysis of Residents’ Health Services Utilization and Expenses Using Big Data
Paper Presentation in a Themed Session Fen Li
The research analyzes Shanghai residents’ use of healthcare services and expenses by using big data and proposes policy responses accordingly. The number of outpatients, inpatients, and emergency patients of people aged sixty to sixty-four in Shanghai surpasses all the age groups in 2016. Among all the people aged sixty and over, 56.28% are went to community health centers for outpatient and emergency services, much higher than children and teen group (0-14, 11.93%) and the middle-young-aged group (15-59, 20.97%). For inpatient services, 80.37% of all the elderly are went to general hospitals while the children and teen group account for 45.23% and the middle-young-aged group 72.67%. Moreover, in terms of medical expenses, people aged 60-64 have the highest amount of hospitalization expenses and then with the age growing, the expense lessens. In addition, the old group has the highest average expense and biggest burden for hospitalization. The research finds that the utilization of medical service of the old group is high with a rather heavy expense burden and the in-patient medical service utilization still relies heavily on hospitals. As the degree of population aging is deepening, exploring an integrated healthcare system is a better solution which can better fulfill the elderly’s health needs and improve the resources utilization efficiency. To date, Shanghai has taken five main actions: the macro design, optimization of resource allocation, improvement of medical service capability, perfection of systematic stimulus mechanism, and the advancement of health informatization. Certain practical experience has been accumulated regarding integrated healthcare systems.
Interdisciplinary Preparation and Service Inequities: Meeting the Needs of Elders in General and Correctional Populations
Paper Presentation in a Themed Session Angela M. Goins, Stephen Wernet
The older adult population in the U.S. will grow dramatically in the next several decades. This population aging will also occur within the criminal justice system. These aging populations require a new and different public discourse regarding government policy and services addressing the needs and desires of both the general population and the correction-based population. Capable workforces trained with geriatric-centered knowledge and skill-sets are required to meet the needs of these aging populations. While faculty of schools of social work are preparing gerontological social workers, faculty of departments of criminal justice are just beginning to recognize and face this change in the correctional populations. A possible solution to meet these growing needs and demands is for social work and criminal justice faculty to collaborate on building a capable workforce able to work with both sets of older adults. This paper presents findings of an exploratory, qualitative study investigating the perceived skills and training needed to serve the growing elder population in the criminal justice system. This study explored the perceptions of criminal justice faculty pertaining to the changing views toward aging and geriatrics in the criminal justice field, and among criminal justice academics. Through content analysis, themes emerged inferring interprofessional, geriatric education is necessary for disciplines that work with older adults. Findings identified the need for interdisciplinary practice, research and educational collaboration between social work and criminal justice professionals. Findings also point to implications for public policy discussions and changes concerning institutional-based and community-based services, and compassionate care.
A Case Study Report into 24-hour Routine Home Visit Practices as a Form of Person-centered Integrated Care in Japan
Paper Presentation in a Themed Session Hiromi Watanabe
The Long-Term Care Insurance Law (LTCI) was established in Japan in 2000 as a form of public care service insurance, managed publicly but designed based on private business models. In 2012, 24-hour routine home visits were introduced through reforms to the LTCI. While this service delivers both fixed-regulation home help and on-call visits, delivery is limited to major cities due to issues with finances, hiring care staff, responding to emergency calls, and providing service at night. In addition, providers of 24-hour routine home visit services are required to offer high quality care catered to individual service users, many of whom have complex care requirements, such as medical conditions, and food, and housekeeping needs. As such, integrated care services must be well coordinated. With the aims of exploring how 24-hour routine home care visits are provided despite running at a financial deficit, and investigating how social care services are coordinated and organized to include self-care, semi-structured interviews were carried out with the managers of four care service providers offering a 24-hour routine home visit service in Tokyo. The results of this case study suggest that, while person-centered integrated care was delivered based on individual patient needs, there is a lack of formalized support structure, which appears to be compensated for by the efforts and professionalism of individual staff.
