How caregivers and workers fared in Cash and Counseling
How caregivers and workers fared in Cash and Counseling
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DOI：
10.1111/j.1475-6773.2006.00672.x
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发表时间：
2007-02-01
影响因子：
3.4
通讯作者：
Brown, Randall
中科院分区：
文献类型：
--
作者：
Foster, Leslie;Dale, Stacy B.;Brown, Randall
目的：评估现金和咨询对医疗补助受益人主要非正式照顾者的影响，并描述他们直接雇佣的工人的经历。研究设置：阿肯色州、佛罗里达州和新泽西州的受益人自愿参加了示范，并被随机分配到指导他们自己的医疗补助支持服务作为现金和咨询消费者（治疗组）或像往常一样依赖医疗补助服务（对照组）。受益人在基线访谈中确定了他们的主要非正式照顾者，在9个月的随访访谈中确定了他们的主要有偿工人。数据来源：通过电话采访护理人员和工作人员收集数据。这些访谈是在受益人随机分配后大约10个月（2000年2月至2003年5月）进行的，具体时间取决于各州。数据分析方法：采用回归模型和logit模型对项目效果进行了估计，并比较了各州直接雇佣工人和中介工人的平均特征。主要发现：与对照组的护理人员相比，治疗组的护理人员在护理、担忧、身体和经济压力方面的满意度有适度到实质性的改善。经过数小时的护理和情绪紧张，治疗组的结果与对照组相似或略好于对照组。直接雇佣的工人对工资的满意度更高，对工作条件的满意度相似，受伤率也与中介工人相似。与受益人有亲属关系的工人比代理工人报告的情绪压力更大。结论：现金和咨询可以减轻照顾残疾儿童或成人的一些负担。雇佣工人的经验表明，消费者导向是一个可持续的选择，但对工人的支持网络可能是一个受欢迎的项目改进。
Objective: To assess the effects of Cash and Counseling on Medicaid beneficiaries' primary informal caregivers and describe the experiences of their directly hired workers.Study Setting: Beneficiaries in Arkansas, Florida, and New Jersey voluntarily enrolled in the demonstration and were randomly assigned to direct their own Medicaid supportive services as Cash and Counseling consumers (the treatment group) or to rely on Medicaid services as usual (the control group). Beneficiaries identified their primary informal caregiver during a baseline interview and their primary paid worker during a 9-month follow-up interview.Data Sources: Data were collected through telephone interviews with caregivers and workers. These interviews were conducted about 10 months after beneficiaries' random assignment, between February 2000 and May 2003, depending on the state.Data Analysis Methods: We estimated program effects with regression and logit models and compared the mean characteristics of directly hired workers and agency workers, by state.Principal Findings: Compared with caregivers in the control group, those in the treatment group had modestly to substantially better outcomes for measures of satisfaction with care, worry, and physical and financial strain. For hours of care and emotional strain, outcomes in the treatment group were similar to or somewhat better than those in the control group. Directly hired workers reported greater satisfaction with wages, similar satisfaction with working conditions, and similar rates of injuries as agency workers. Workers who were related to the beneficiary reported more emotional strain than agency workers.Conclusions: Cash and Counseling can lessen some of the burden associated with caring for a child or adult with disabilities. The experiences of hired workers suggest consumer direction is a sustainable option, but support networks for workers might be a welcome program improvement.