Moral Hazard and Long-Term Care Insurance

描述（由申请人提供）：作为卫生改革的一部分，最近通过的《社区生活援助服务和支持法》（CLASS）重新引起了人们对长期护理保险市场的关注，长期以来，该市场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也不均衡，但只有10%的老年人有长期护理保险，因此保险公司对逆向选择和道德风险的关注程度高于典型的健康保险市场。虽然有限的研究机构已经开始在了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。无论CLASS的最终命运或形式如何，长期护理使用的预计人口统计数据以及政府预算的相关压力都表明越来越迫切需要回答这些问题。一个特别缺乏研究的领域是道德风险，或可归因于长期护理保险的额外使用服务。现有的研究发现，在医疗补助资助的疗养院使用的情况下，道德风险的证据很少，但医疗补助资助的疗养院使用可能被认为是一个劣质的好。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。一个更广泛的视角，包括所有的养老院使用和特别有利的替代养老院，如家庭护理，需要充分捕捉道德风险的程度。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共同假设，相反，假定归因于收入效应的道德风险是有效率的和福利改善的，而归因于价格效应的道德风险仍然是无效率的和福利减少的。这种区别在长期护理中可能特别重要，这是一个公共支付者目前占主导地位的卫生保健领域。在本项目中，我们建议使用健康与退休研究的一个长面板来1）评估与长期护理保险覆盖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导致的有效道德风险和由于价格效应导致的无效道德风险，从而能够评估净福利效应;（3）进行政策模拟，以协助设计适当的福利。评估与长期护理保险覆盖范围相关的道德风险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评估CLASS等公共政策的整体福利影响至关重要。 公共卫生相关性：长期以来，政策制定者一直未能找到为长期护理筹资的合理解决方案，随着人口老龄化，这一挑战的重要性可能会增加。本项目拟调查在存在保险覆盖的情况下长期护理利用的程度和性质，研究长期护理保险市场的财务可行性和可持续性，适当的福利设计，以及评估旨在解决长期护理融资问题的公共政策的整体福利效果。

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.