Edward Alan Miller, Ph.D., M.P.A., Vincent Mor, Ph.D., and Melissa A. Clark, Ph.D.
E. A. Miller, V. Mor, and M. A. Clark, "Weighing Public and Private Options for Reforming Long-Term Care Financing: Findings from a National Survey of Specialists," Medical Care Research and Review, Aug. 2010 67(4 Suppl.):16S–37S.
Debate around long-term care financing reform has traditionally focused on the public and private sectors’ relative roles in meeting the needs of the growing population of frail and disabled elders. Published in a special supplement to Medical Care Research and Review, results from the Commonwealth Fund Survey of Long-Term Care Specialists highlight the characteristics that predispose long-term care specialists to weigh one approach—public or private—more than the other.
Two-thirds of the 1,147 survey respondents ranked financing reform among the top three challenges facing long-term care. Approximately four-fifths of specialists favored or strongly favored both private sector financing and Medicare/Medicaid reform, while more than half favored or strongly favored bolstering the government role. Those who most strongly favored greater private sector financing tended to be younger, were less well-educated, identified themselves as Republicans or Independents, or had personal experience working in nursing home care. Those most strongly favoring Medicare/Medicaid reform tended to be better-educated, Democrats, and employed at a university or other academic institution. And those who most strongly favored increasing the government’s role in long-term care financing tended to be older, better-educated, Democrats who had spent more than five years working in long-term care as an academic, consumer advocate, or researcher/consultant.
Despite the differences in perspective they found, the authors note the apparent agreement among long-term care specialists that the current mix of financing options, both public and private, "is unsustainable, not only if we are to meet the increased demand for [long-term] care ahead but also if we are to satisfy substantial levels of unmet need among the current population of elders."