Informal Care of Older Adults and Medicare Expenditures

描述（由申请人提供）：老年人的成年子女对老年人的非正式照顾是一种常见的长期照顾形式，通常是老年人比正式照顾更喜欢的，如果它替代了正式照顾，可以减少医疗保险支出。虽然我们对非正式护理人员了解很多，但直到最近才有研究人员量化非正式护理是长期护理的净替代品。人们对非正式护理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年）。这项拟议的研究将确定正规护理从非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的医疗保险支出的减少。将分析适合解决非正式护理和医疗保险支出问题的独特数据。这些数据是医疗保险索赔与最年长人群的资产和健康动态调查合并而成的。长期的面板数据期（1992-2000）允许对70岁及以上的全国代表性样本的非正式和正式护理行为进行丰富的观察，并且需要使用纵向数据分析方法。此外，预测支出时的非正式关心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。两部分支出模型将用于模拟老年人在家庭保健、熟练护理和医院使用方面的支出行为。非正式护理很重要，因为它是面临失去独立性的老年人的第一道防线。最终，非正式护理会影响年老体弱者的健康状况、他们独立生活的能力和医疗保健支出。发现非正式护理和医疗保险支出之间的关系将有力地推动对医疗补助支出的审查，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的预测，并将开始告知有关护理政策的成本效益的政策过程。

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.