Who pays for home care? A study of nationally representative data on disabled older Americans.
Who pays for home care? A study of nationally representative data on disabled older Americans.
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DOI：
10.1186/s12913-015-0978-x
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发表时间：
2015-07-31
影响因子：
2.8
通讯作者：
Ermisch J
中科院分区：
文献类型：
--
作者：
Janus AL;Ermisch J
我们调查了谁来支付赡养美国残疾老人的费用。我们认为个人来源（例如，自付费用，家庭成员）和公共资助项目（例如，医疗补助计划）都是服务的支付来源。我们研究了家庭护理服务的资金组合如何与老年人的经济资源、护理需求和其他社会人口特征相关。我们的样本包括1989年、1994年、1999年和2004年全国长期护理调查浪潮中的11725人年。进行了两部分回归分析，以模拟从每个付款人那里获得的护理时间。“随机效应”和“固定效应”估计得出了类似的结果。提供家庭护理服务的护理人员中约有六成（63%）仅靠个人来源支付费用。相比之下，28%的学生仅从公共资助项目中获得资助，9%的学生从个人和公共项目来源中获得资助。家庭年收入超过75,000美元的老年人比最低收入类别（低于15,000美元）的老年人总体上多获得8.5小时的家庭护理时间。虽然家庭护理服务的供资组合与老年人的经济资源密切相关，但在所有收入群体中，至少65%的服务是由全部或部分由个人来源支付的护理人员提供的。事实上，家庭年收入超过75000美元的人几乎所有（97%）的家庭护理都是由个人负担的。我们概述了严重依赖个人资助的服务和总体服务使用中的经济差异对美国残疾老年人及其家庭的影响。本文的在线版本（doi:10.1186/s12913-015-0978-x）包含补充材料，可供授权用户使用。
We examine who pays for services that support disabled older Americans at home. We consider both personal sources (e.g., out-of-pocket payment, family members) and publicly funded programs (e.g., Medicaid) as sources of payment for services. We examine how the funding mix for home care services is related to older people’s economic resources, needs for care, and other socio-demographic characteristics. Our sample consists of 11,725 person-years from the 1989, 1994, 1999, and 2004 waves of the National Long-Term Care Survey. Two-part regression analyses were performed to model hours of care received from each payer. “Random effects” and “fixed effects” estimation yielded similar results. About six in ten caregivers (63 %) providing home care services are paid by personal sources alone. By contrast, 28 % receive payment from publicly funded programs alone, and 9 % from a combination of personal and public program sources. Older people with family incomes over 75,000 dollars per year receive 8.5 more hours of home care overall than those in the lowest income category (less than 15,000 dollars). While the funding mix for home care services is strongly related to older people’s economic resources, in all income groups at least 65 % of services are provided by caregivers paid in whole or in part from personal sources. In fact, almost all (97 %) home care received by those with family incomes over 75,000 dollars per year are financed by personal sources alone. We outline the implications that heavy reliance on personally financed services and economic disparities in overall services use has for disabled older Americans and their families. The online version of this article (doi:10.1186/s12913-015-0978-x) contains supplementary material, which is available to authorized users.