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DOI: 10.1177/0898264302239016 Titrating Versus Targeting Home Care Services to Frail Elderly Clients:An Application of Agency Theory and Cost-Benefit Analysis to Home Care Policy
The University of Michigan The article summarizes the shortcomings of current home care targeting policy, provides a conceptual framework for understanding the sources of its problems, and proposes an alternative resource allocation method. Methods required for different aspects of the study included synthesis of the published literature, regression analysis of risk predictors, and comparison of actual resource allocations with simulated budgets. Problems of imperfect agency ranging from unclear goals and inappropriate incentives to lack of information about the marginal effectiveness of home care could be mitigated with an improved budgeting method that combines client selection and resource allocation. No program can produce its best outcome performance when its goals are unclear and its technology is unstandardized. Titration of care would reallocate resources to maximize marginal benefit for marginal cost.
Key Words: case management • cost-effectiveness • performance payment • home care
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