Public Policy and the Demand for Long-Term Care Insurance

公共政策和长期护理保险的需求

• 批准号: 8212656
• 负责人: DAVID C GRABOWSKI
• 金额: $ 32.75万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8212656
• 关键词: Accounting; Acute; Age; Attitude; Caring; Characteristics; Charge; Data; Databases; Demographic Factors; Disability Insurance; Elderly; Eligibility Determination; Enrollment; Family; Future; Government; Government Financing; Growth; Health; Incentives; Income; Individual; Insurance; Laws; Lead; Left; Light; Link; Long-Term Care; Long-Term Care Insurance; Marketing; Medicaid; Medical; Medicare; Modeling; Myopia; Nature; Participant; Patients; Persons; Play; Policies; Population; Program Sustainability; Public Policy; Relative (related person); Research; Research Infrastructure; Research Personnel; Resort; Retirement; Risk; Role; Services; Shapes; Simulate; Source; State Government; Structure; Supportive assistance; Surveys; Taxes; Time; Uncertainty; United States; care systems; caregiving; community living; cost; design; early experience; expectation; experience; insight; meetings; novel; payment; programs; public-private partnership; safety net; success; trait

DESCRIPTION (provided by applicant): The financing of long-term care is an increasingly important issue for the elderly and our population as a whole. We propose to use two novel databases to study the demand for long-term care insurance (LTCi) and to consider the potential role of governmental policy moving forward. These data include multiple waves of detailed survey information on buyers and non-buyers of LTCi policies and longitudinal enrollment and utilization data from the state Long-Term Care Partnership Program, a public-private partnership between states and insurance companies designed to reduce Medicaid spending by delaying or eliminating the need for some people to rely on Medicaid for long-term care services. Relative to previous research, we will have much more detailed information on individuals' attitudes and opinions about long-term care, family caregiving, and related government policies; the primary reasons for purchase/non-purchase of LTCi; and demographics factors relevant to purchase decisions, including asset and income levels. For LTCi buyers, these detailed survey data are linked to information on level of policies that were purchased. Thus, our first two research aims are to analyze the effect of individual factors, such as demographic traits and attitudes about the intertwined roles of family caregiving, Medicaid, and private insurance, and state-level factors, such as Medicaid eligibility policies, tax incentives, and the presence of a Partnership Program, on 1) the purchase of LTCi and 2) the level of LTCi policy that was purchased. Both of these analyses will use person-level survey data merged with state-level policy factors to model the effect of individual and state traits on LTCi purchase. The analyses will exploit the longitudinal nature of the survey data (surveys were conducted in 1990, 1995, 2000, 2005, and 2010) to account for unobserved, time invariant state characteristics that may be correlated with both LTCi purchase and state policy features (e.g., tax incentives for LTCi). Understanding the key determinants of individuals' decision to purchase LTCi can help shape relevant government policies and marketing campaigns, including product targeting for the Community Living Assistance and Supportive Services (CLASS) program. The third aim of our project is i) to describe the early experience of state Long- Term Care Partnership Programs in terms of the number and type of policies sold and the claims experience of enrollees and ii) to simulate the potential effect of these programs on future Medicaid long-term care spending. To accomplish these aims, we will use detailed information on policies, policyholders, and claimants available from all state LTC Partnership Programs merged with information from the 2010 LTCi buyers survey (e.g., the asset/income levels of purchasers of Partnership policies) and long-term care utilization data from similar individuals in the Health and Retirement Survey. Evaluating the early experience of state Partnership programs can help shape expectations for the program going forward, particularly around its ability to impact Medicaid spending. PUBLIC HEALTH RELEVANCE: To date, private long-term care insurance has played a minimal role in financing long-term care in the United States; instead, out of pocket payments and public financing through state Medicaid programs have played primary roles, leaving individuals, families, and state governments vulnerable to the potentially catastrophic costs of long-term services and supports. We propose to use two key databases to study the factors influencing the demand for long-term care insurance and the role of government policy moving forward, including multiple waves of survey data from buyers and non-buyers of LTCi policies and longitudinal enrollment and utilization data from the Long-Term Care Partnership Program, a public-private partnership between states and insurance companies designed to reduce Medicaid spending by delaying or eliminating the need for some people to rely on Medicaid for long-term care services. By shedding light on key factors that influence the demand for insurance and the early experience of the LTC Partnership program, our analyses will offer key insights for policymakers as they implement and refine the government's approach to financing long- term care in the future.

描述（由申请人提供）：长期护理的融资对老年人和我们整个人口来说是一个越来越重要的问题。我们建议使用两个新的数据库来研究长期护理保险（LTCi）的需求，并考虑政府政策向前发展的潜在作用。这些数据包括关于LTCi政策的购买者和非购买者的多波详细调查信息，以及来自州长期护理合作伙伴计划的纵向注册和利用数据，该计划是州和保险公司之间的公私合作伙伴关系，旨在通过延迟或消除一些人依赖医疗补助进行长期护理服务的需要来减少医疗补助支出。相对于以前的研究，我们将有更详细的信息，个人的态度和意见，对长期护理，家庭养老，和相关的政府政策;购买/不购买LTCI的主要原因;和相关的购买决策，包括资产和收入水平的人口统计因素。对于LTCi买家，这些详细的调查数据与购买的保单级别相关。因此，我们的前两个研究目的是分析个人因素的影响，如人口统计学特征和态度的相互交织的作用，家庭养老，医疗补助，和私人保险，和国家层面的因素，如医疗补助资格政策，税收优惠，并存在一个合作伙伴计划，对1）购买LTCI和2）购买LTCI政策的水平。这两项分析都将使用个人层面的调查数据与国家层面的政策因素相结合，以模拟个人和国家特征对LTCI购买的影响。这些分析将利用调查数据的纵向性质（调查在1990年、1995年、2000年、2005年和2010年进行），以解释可能与LTCi购买和国家政策特征（例如，对LTCI的税收优惠）。了解个人决定购买LTCI的关键决定因素可以帮助制定相关的政府政策和营销活动，包括社区生活援助和支持服务（CLASS）计划的产品定位。我们项目的第三个目标是：i）描述州长期护理合作计划在售出保单数量和类型以及投保人索赔经验方面的早期经验; ii）模拟这些计划对未来医疗补助长期护理支出的潜在影响。为了实现这些目标，我们将使用所有州LTC合作伙伴计划提供的有关保单、投保人和索赔人的详细信息，并将其与2010年LTCI买家调查的信息合并（例如，伙伴关系政策购买者的资产/收入水平）和健康和退休调查中类似个人的长期护理利用数据。评估州伙伴关系计划的早期经验可以帮助塑造对该计划未来的预期，特别是围绕其影响医疗补助支出的能力。 公共卫生关系：迄今为止，私人长期护理保险在美国长期护理融资方面发挥的作用微乎其微;相反，通过州医疗补助计划进行的自付和公共融资发挥了主要作用，使个人，家庭和州政府容易受到长期服务和支持的潜在灾难性成本的影响。我们建议使用两个关键数据库来研究影响长期护理保险需求的因素和政府政策向前发展的作用，包括来自LTCI政策购买者和非购买者的多波调查数据以及来自长期护理合作伙伴计划的纵向登记和利用数据，州政府和保险公司之间的公私合作伙伴关系，旨在通过延迟或消除一些人长期依赖医疗补助的需要来减少医疗补助支出，定期护理服务。通过揭示影响保险需求的关键因素和LTC合作伙伴计划的早期经验，我们的分析将为政策制定者提供关键见解，因为他们实施和完善政府未来为长期护理提供资金的方法。