Insurance coverage, long-term care utilization, and health outcomes
Insurance coverage, long-term care utilization, and health outcomes
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DOI：
10.1007/s10198-022-01550-x
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发表时间：
2022-12
期刊：
影响因子：
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通讯作者：
Masaki Takahashi
中科院分区：
文献类型：
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作者：
Masaki Takahashi
社会保险覆盖面的慷慨程度如何影响老年人的医疗保健需求和健康状况？本文利用日本公共长期护理保险（LTCI）系统的管理数据，研究了保险范围对长期护理（LTC）利用的影响及其健康后果。在 LTCI 中，接受者的健康评分决定了他们的保险承保限额，并且分数的阈值会导致承保限额水平发生不连续的变化。我实施了断点回归设计，发现覆盖范围的扩大大大提高了受助者的 LTC 利用率，无论他们的健康状况如何。当提供更慷慨的保险覆盖范围时，护理需求低的接受者会增加日托和康复服务，而护理需求高的接受者会增加家庭护理服务。此外，使用更多的 LTC 对健康结果（例如健康评分和进入疗养院）影响不大。总之，这些结果表明，慷慨的 LTCI 保险可能会导致 LTC 的过度利用，而不会带来健康益处。
How does the generosity of social insurance coverage affect the demand for healthcare and health outcomes of elderly people? This paper presents an examination of the effects of insurance coverage on long-term care (LTC) utilization and its health consequences using administrative data of the public long-term care insurance (LTCI) system in Japan. In LTCI, a recipient’s health score determines their insurance coverage limit, and thresholds of the score generate discontinuous changes in the level of coverage limits. I implement a regression discontinuity design and find that coverage expansion increases recipients’ LTC utilization considerably irrespective of their health status. When more generous insurance coverage is available, recipients with low care needs increase day care and rehabilitation services, whereas those with high care needs increase home care services. Moreover, using more LTC has little effect on health outcomes such as the health score and the entry into nursing homes. Together, these results suggest that generous LTCI coverage can induce excessive LTC utilization without having health benefits.