Table 2.

Basic characteristics of two American models

	Social health maintenance organisation (I and II)	Program of all-inclusive care for the elderly
Status	Demonstration authorised by U.S. Congress, 1984 Operational, 1985	Based on On Lok Senior Health Services, founded 1979
	Permanent federal status anticipated, 2001	Permanent federal status, 1997
Targeting	Age 65 and over	Age 55 and over
	Able-bodied, and frail elderly certified for nursing home admission	Frail elderly certified for nursing home admission
Benefit package	Comprehensive acute and ancillary services	Comprehensive acute and ancillary services
	Limited long term care, primarily home- and community-based services	Comprehensive long term care
Financing	Prepaid Medicare (risk-adjusted rate) and Medicaid capitation	Prepaid Medicare (risk-adjusted rate) and Medicaid capitation
	Supplemental premiums and co-payments for Medicare-only enrolees	Full risk for all services
	Full risk for all services
Delivery system and clinical management	Based on traditional health maintenance organisation model	Based on adult day health care model, integrated with primary care
	Network comprised of individual providers, provider groups, and/or salaried staff	Most services provided by salaried staff
	Care management responsibility shared by primary care physician and non-medical long term care co-ordinator	Care management by interdisciplinary team
Enrolment	Voluntary	Voluntary
	Minimum of 5000 enrolees/site	Minimum of 300 enrolees/site
	4 sites	34 full sites
	Approximately 85,000 enrolees	Approximately 6000 enrolees

Source: Adapted from Kodner [3].