Moral Hazard and Long-Term Care Insurance

描述(由申请人提供)：作为医疗改革的一部分，最近通过的《社区生活援助服务和支持(类)法》再次引起了人们对长期护理保险市场的关注，这个市场长期以来一直向研究人员和政策制定者提出许多悬而未决的问题。尽管长期护理的潜在成本很高，而且这些成本的分布不平衡，但只有10%的老年人拥有长期护理保险，因此保险公司对逆向选择和道德风险的担忧比典型的健康保险市场更大。虽然有限的研究已经开始在理解长期护理保险市场和相关行为方面取得进展，但逆向选择和道德风险的程度在很大程度上仍然未知。不管最终的命运或阶级的形式如何，长期护理使用的预测人口统计数据以及相关的政府预算压力表明，越来越迫切需要回答这些问题。一个研究特别不足的领域是道德风险，或可归因于长期护理保险覆盖范围的服务的额外使用。现有的研究发现，在医疗补助资助的疗养院使用中几乎没有道德风险的证据，但医疗补助资助的疗养院使用可能被认为是次要的商品。家庭保健和私人资助的疗养院使用可能是正常的商品，因此更有可能受到道德风险的影响。需要更广泛的视角，包括所有养老院的使用，特别是养老院的有利替代方案，如家庭护理，以全面了解道德风险的程度。此外，最近的理论工作重新审视了所有道德风险都是福利减少的普遍假设，转而假设可归因于收入效应的道德风险是有效的和福利改善的，而可归因于价格效应的道德风险仍然是低效率和福利减少的。这一区别在长期护理中可能尤其重要，这是目前公共支付者占主导地位的卫生保健领域。在这个项目中，我们建议使用健康和退休研究的一个长小组来1)评估与长期护理保险覆盖范围相关的道德风险的总体程度，包括使用家庭护理；2)将估计的道德风险分解为由于收入效应而产生的有效道德风险和由于价格效应而导致的无效道德风险，从而能够评估净福利效应；以及3)进行政策模拟，以帮助进行适当的福利设计。评估与长期护理保险覆盖相关的道德风险的程度对于市场的财务可行性和可持续性、适当的福利设计以及对诸如班级等公共政策的整体福利影响的评估是至关重要的。 公共卫生相关性：长期护理筹资的合理解决方案长期以来一直未为决策者所知，随着人口老龄化，这一挑战有望变得更加重要。该项目建议在有保险覆盖的情况下调查长期护理利用的范围和性质，对长期护理保险市场的财务可行性和可持续性至关重要的研究，适当的福利设计，以及对旨在解决长期护理筹资问题的公共政策的整体福利影响的评估。

DESCRIPTION (provided by applicant): Recent passage of the Community Living Assistance Services and Supports (CLASS) Act as part of health reform has drawn renewed attention to the long-term care insurance market, a market which has long presented many unanswered questions to researchers and policymakers. Despite the potentially high cost of long-term care and the skewed distribution of those costs, only 10 percent of elderly adults have long-term care insurance, and insurers consequently express greater concern about adverse selection and moral hazard than in typical health insurance markets. While a limited body of research has begun to make progress in understanding long-term care insurance markets and associated behavior, the extent of adverse selection and moral hazard remain largely unknown. Regardless of the eventual fate or form of CLASS, the projected demographics of long-term care use and the associated strain on government budgets point to a more and more urgent need to answer these questions. A particularly under-researched area is that of moral hazard, or the additional use of services that can be attributed to long-term care insurance coverage. Existing research finds little evidence for moral hazard in the case of Medicaid-financed nursing home use, but Medicaid- financed nursing home use may be considered an inferior good. Home health care and privately financed nursing home use may be normal goods and thus more likely to be subject to moral hazard. A broader perspective, including all nursing home use and especially favorable alternatives to nursing homes, such as home care, is required in order to capture fully the extent of moral hazard. Furthermore, recent theoretical work has revisited the common assumption that all moral hazard is welfare-reducing, positing instead that moral hazard attributable to income effects is efficient and welfare-improving while moral hazard attributable to price effects remains inefficient and welfare-reducing. This distinction may be particularly important in long- term care, an area of health care in which public payers currently dominate. In this project, we propose to use a long panel of the Health and Retirement Study to 1) assess the overall extent of moral hazard associated with long-term care insurance coverage, including use of home care; 2) disentangle the estimated moral hazard into efficient moral hazard due to the income effect and inefficient moral hazard due to the price effect, thereby enabling an assessment of the net welfare effect; and 3) conduct policy simulations to aid in appropriate benefit design. Assessing the extent of moral hazard associated with long-term care insurance coverage is essential to financial viability and sustainability of the market, to appropriate benefit design, and to an assessment of the overall welfare effects of a public policy such as CLASS. PUBLIC HEALTH RELEVANCE: Reasonable solutions to the financing of long-term care have long eluded policymakers and this challenge promises to increase in importance as the population ages. This project proposes to investigate the extent and nature of long-term care utilization in the presence of insurance coverage, research that is essential to financial viability and sustainability of the long-term care insurance market, to appropriate benefit design, and to an assessment of the overall welfare effects of a public policies designed to address long-term care financing.