Medicaid enrollment among elderly medicare beneficiaries: Individual determinants, effects of state policy, and impact on service use
Medicaid enrollment among elderly medicare beneficiaries: Individual determinants, effects of state policy, and impact on service use
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DOI：
10.1034/j.1600-0560.2002.55.x
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发表时间：
2002-08-01
影响因子：
3.4
通讯作者：
Kasper, JD
中科院分区：
文献类型：
--
作者：
Pezzin, LE;Kasper, JD
目标。为了更好地了解与低收入、社区居住的老年儿子参加医疗补助相关的因素，并检查医疗补助登记对老年儿子使用医疗保健服务的影响，同时考虑到计划参与的选择。1996年联邦医疗保险当前受益人调查(MCBS)获得医疗服务和费用及使用文件。对双重登记概率的个人水平的预测是从联合估计医疗保险受益人(社区与机构)的居住状态和社区居住的合格受益人中参加医疗补助的概率的方程获得的。然后将预测值代入服务使用方程式，通过两部分模型进行估计。1996年，收入达到或低于联邦贫困水平100%的所有居住在社区的老年人中，只有不到一半的人参加了医疗补助：一旦考虑到选择性登记，对服务使用产生双重登记影响的证据就很有限。虽然州医疗补助政策变量对受益人居住在社区(而不是养老院)的概率没有影响，但州医疗补助在家庭和社区服务中的慷慨程度对符合条件的老年人参加医疗补助的可能性有相当大的影响，在统计学上具有显著意义。我们的结果提供了令人信服的证据，证明医疗补助的参与可以受到州政策的影响。“政策很重要”的观察为现有计划如何接触到更大比例的潜在符合条件的受益人提供了新的见解。
Objective. To better understand factors associated with Medicaid enrollment among low-income, community-dwelling elderly per-sons and to examine the effect of Medicaid enrollment on the use of health care services by elderly per-sons, taking into account selection in program participation.Data Sources. 1996 Medicare Current Beneficiary Survey (MCBS) Access to Care and Cost and Use files.Methods. Individual-level predictions of the probability of dual enrollment are obtained from equations that estimate jointly the residential status of Medicare beneficiaries (community versus institution) and the probability of Medicaid enrollment among community-dwelling eligible beneficiaries. Predicted values are then substituted into the service use equations, which are estimated via two-part models.Principal Findings. Less than half of all community-dwelling elderly persons with incomes at or below 100 percent of the Federal Poverty Level (FPL) were enrolled in Medicaid in 1996: Once selective enrollment was accounted for, there was limited evidence of a dual enrollment effect on service use. Although there were no effects of state Medicaid policy variables on the probability that beneficiaries lived in the community (as opposed to nursing homes), the effects of state's Medicaid generosity in home and community-based services had a sizeable and statistically significant effect on influencing the likelihood that eligible elderly persons enrolled in Medicaid.Conclusions. Our results provide compelling evidence that Medicaid participation can be influenced by state policy. The observation that "policy matters" provides new insights into how existing programs might reach a larger proportion of potentially eligible beneficiaries.