| In modern society, equal access to health care is often regarded as a right of citizenship. There is, however, little consensus as to why a health care policy of reducing inequalities is important. This is mainly due to lack of a working principle for a right to health care. This study provides a systematic discussion of the link between the welfare state, distributive justice, and long-term health care service utilization.; The purposes of this study are two. The first is to evaluate the long-term care policies for the elderly in the United States. The second is to examine the equity in the distribution of long-term care services for the elderly.; This study is a secondary analysis of survey data. The main data source is the National Long-Term Care Surveys (NLTCS) of 1982, 1984, and 1989. The research design employed for this study is a multinomial logistic regression model predicting the relative probability in each of four utilization patterns, based on the values of 1982.; The findings indicate that the American long-term care system can be characterized as a system with a low de-commodification score. With this residual system, elderly people are not treated as valuable individuals. They are also not entitled by government to an equal right to use a variety of long-term care services when needed. Rather, they come to depend entirely on the informal sector and the market, which is exclusively determined by their economic capabilities.; Long-term care services are distributed unequally among various social groups. The need indicator is not the only determinant of services utilization. Socio-demographic factors such as age, race, gender, education, family size, marital status, and attitude toward nursing home care are also important for services utilization. The effect of long-term care policies on services utilization is small. Different from previous studies, Medicaid recipients are more likely to receive care from professional personnel or paid helpers than non-Medicaid recipients. But, Medicare beneficiaries are more likely to move into nursing homes than non-Medicare beneficiaries. |
