Informal Care of Older Adults and Medicare Expenditures

描述(由申请人提供)：由成年子女对老年人进行非正式护理是一种常见的长期护理形式，与正规护理相比，老年人往往更喜欢非正规护理，如果替代正规护理，可以减少医疗保险支出。虽然我们对非正式照顾者了解很多，但直到最近，研究人员才量化了非正式护理是长期护理的净替代品。人们对非正规医疗如何影响医疗保险支出知之甚少，但对医疗保险信托基金偿付能力的担忧正在升级。医疗保险受托人目前的预测显示，医疗保险信托基金将在2029年耗尽(CMS，2001)。这项拟议的研究将确定正规护理的减少是否会导致家庭健康、熟练护理和医院使用方面的医疗保险支出的减少。将分析唯一适合于解决非正式护理和医疗保险支出问题的数据。这些数据是合并了资产和健康动态的联邦医疗保险索赔，属于最古老的小组调查。较长的小组数据期(1992-2000年)允许对具有全国代表性的70岁及以上成年人样本的非正式和正式护理行为有一个丰富的看法，并需要使用纵向数据分析方法。此外，非正式护理在预测支出方面的内生性要求使用联立方程方法。工具变量(IV)估计将用于控制内生性，使用已在许多研究中使用和验证的儿童水平识别工具。两部分支出模型将被用来模拟老年人在家庭健康、熟练护理和医院使用方面的支出行为。非正式护理很重要，因为它是面临丧失独立性的老年人的第一道防线。归根结底，非正规护理会影响虚弱老年人的健康状况、他们独立生活的能力以及医疗保健支出。找到非正式护理和医疗保险支出之间的关系将为审查医疗补助支出提供强大的动力，将向政策制定者发出信号，将非正式护理供应的变化纳入医疗保险信托基金预测，并将开始向政策过程通报护理者政策的成本效益。

DESCRIPTION (provided by applicant): Informal care of the elderly by their adult children is a common form of long-term care, is often preferred by the elderly to formal care, and can reduce Medicare expenditures if it substitutes for formal care. While we know a great deal about informal caregivers, only recently have researchers quantified that informal care is a net substitute for long-term care. Little is known about how informal care affects Medicare expenditures, yet concerns about the solvency of the Medicare trust fund are escalating. Current projections by the Medicare Trustees show that the Medicare trust fund will be depleted in the year 2029 (CMS, 2001). This proposed study will determine whether the reductions in formal care from informal care lead to reductions in Medicare expenditures for home health, skilled nursing, and hospital use. Data uniquely suited to address questions of informal care and Medicare expenditures will be analyzed. The data are Medicare Claims merged with the Asset and Health Dynamics Among the Oldest-Old panel survey. The long panel data period (1992-2000) allows for a rich view of informal and formal care behavior for a nationally representative sample of adults age 70 and above, and requires use of longitudinal data analysis methods. In addition, the endogeneity of informal care in predicting expenditures requires the use of simultaneous equations methods. Instrumental variables (IV) estimation will be used to control for endogeneity, using child-level identifying instruments that have been used and validated in numerous studies. Two-part expenditure models will be used to model the expenditure behavior of the elderly for home health, skilled nursing, and hospital use. Informal care is important because it is the first line of defense for older adults who have faced a loss of independence. Ultimately informal care a effects the health status of the frail elderly, their ability to live independently, and expenditures on health care. Finding a relationship between informal care and Medicare expenditures would provide a strong impetus to examine Medicaid expenditures, would signal policymakers to include informal care supply changes in Medicare Trust fund projections, and would begin to inform the policy process about the cost-effectiveness of caregiver policies.