Meeting the need for personal care among the elderly: Does medicaid home care spending matter?
Meeting the need for personal care among the elderly: Does medicaid home care spending matter?
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DOI：
10.1111/j.1475-6773.2007.00762.x
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发表时间：
2008-02-01
影响因子：
3.4
通讯作者：
Kang, Hyojin
中科院分区：
文献类型：
--
作者：
Kemper, Peter;Weaver, France;Kang, Hyojin
Objective.确定医疗补助家庭护理支出是否降低了没有得到个人护理帮助的残疾老年人口的比例。每个州贫困老年人的医疗补助家庭护理支出数据与1992年、1996年和2000年医疗保险当前受益人调查的数据合并。样本（n= 6，067）包括生活在社区中的老年人，他们至少有一种日常生活活动（ADL）的限制。使用重复的横截面分析，没有得到帮助的ADL的概率估计作为一个功能的医疗补助家庭护理支出，个人收入，收入和支出之间的相互作用，以及一组个人特征。由于医疗补助家庭护理支出针对的是低收入人群，预计不会影响收入较高的人群。我们利用这种差异，使用高收入群体作为比较组，以评估是否未观察到的状态特征偏差的估计。在低收入残疾老年人中，在人均医疗补助家庭护理支出最高的四分之一的州，没有接受ADL限制帮助的可能性比其他州低约10个百分点。在高收入群体中没有观察到这种关联。这些结果是稳健的一组敏感性分析的方法。这些发现应该让州和联邦政策制定者放心，他们正在考虑扩大医疗补助家庭护理计划，他们确实为有长期护理需求的低收入人群提供服务，并减少那些得不到帮助的人的比例。
Objective. To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care.Data Sources. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs).Study designs. Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates.Principal Findings. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods.Conclusion. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help.