MEDICAL CARE OF THE DISABLED ELDERLY

用于老年人保健的公共开支正在以无情的速度增长。该分项目将研究残疾老年人在这一支出增长中的作用，认识到这一群体的命运对医疗保险和医疗补助费用的影响不成比例，因为他们比非残疾人更倾向于需要住院和强化医疗。了解老年人口中残疾的演变情况以及特定残疾如何与慢性病和医疗需求相互作用，是预测这一高费用群体未来保健支出所需知识的重要来源。为了发展这方面的知识，本次级项目将侧重于以下具体目标：（1）综合我们对残疾趋势的理解，（2）建立残疾和慢性病之间的跨期联系，（3）研究残疾和慢性病死亡率的演变，（4）制定与医疗保险/医疗补助支出和残疾有关的终身概况，（5）提供评估政策改革影响的能力。为了进行这项全面的研究，这个子项目将利用各种各样的调查数据来源的老年人，结合复杂的纵向文件，从医疗保险和医疗补助登记和索赔数据，详细说明成本和使用的医疗服务。我们的实证工作将依赖于两个基本的实证框架，能够总结事件和支出如何随着时间的推移和跨年龄的演变：“队列”配置文件，其特征是特定群体的结果或支出分布如何随着时间的推移和跨年龄的变化;以及在纵向设置中对个人的动态分位数的估计，揭示了一生中健康状况和支出的持续程度。

Public expenditures on health care for the elderly are rising at a relentless rate. This subproject will study the role of the disabled elderly in this expenditure growth, recognizing that the fate of this group has a disproportionate impact on Medicare and Medicaid expenses due to their greater tendency to require hospitalization and intensive medical treatments than their non-disabled counterparts. Learning about the evolution of disabilities in the elderly population in conjunction with how particular disabilities interplay with chronic illnesses and medical needs constitutes a vital source of knowledge required to project future health-care expenditures by this high cost group. To develop this knowledge, this subproject will focus on the following specific aims: (1) synthesize our understanding of trends in disability, (2) establish the intertemporal links between disabilities and chronic illnesses, (3) examine evolution of mortality rates for disabilities and chronic diseases, (4) develop lifetime profiles relating Medicare/Medicaid expenditures and disabilities, and (5) provide a capacity for evaluating implications of policy reforms. To conduct this comprehensive study, this subproject will exploit a wide variety of survey data sources on the elderly, in combination with sophisticated longitudinal files constructed from Medicare and Medicaid enrollment and claims data detailing costs and use of medical services. Our empirical work will rely on two basic empirical frameworks capable of summarizing how events and expenditures evolve over time and across ages: "cohort" profiles characterizing how outcomes or expenditure distributions change over time and across ages for specific groups; and the estimation of dynamic quantiles for individuals in a longitudinal setting revealing the degree of the persistence in health conditions and expenditures over a lifetime.