The cost-effectiveness of noninstitutional long-term care services: Review and synthesis of the most recent evidence

There has been significant expansion and change in the financing, coverage, and delivery of home- and community-based services during the past decade. This article reviews the cost-effectiveness of Medicaid waiver programs, consumer-directed care, capitated models that blend acute and long-term care services, and case management and subsidized community services for individuals with dementia. Generally, these new care models were found to be associated with increased costs, but greater client and caregiver welfare. Depending on the specific features of the program, capitated care models and consumer-directed care were identified as potential mechanisms toward providing services more efficiently. Importantly, however, most recent evaluations have relied on potentially confounded research designs, which leaves open the question of whether the findings relate to the programs or biased selection across the treatment and comparison groups.