Family Structure, Informal Care and Long-term Care Insurance

描述（由申请人提供）：家庭结构，非正式护理和长期护理保险长期护理（LTC）是当今老年人面临的最大财务风险之一，但很少有人-目前65岁的13%-为自筹资金的LTC风险投保。这种保险覆盖面的缺乏促使公共政策采取行动，截至2008年，超过一半的州为购买私人长期保险（LTCI）提供税收减免。然而，到目前为止，LTCI的购买仍然对政策变化持反对态度，既没有大幅增加医疗保险的覆盖面，也没有节省医疗补助的成本。最近通过的《社区生活和支持服务法》（CLASS）是迄今为止LTCI市场最彻底的变化。然而，为了充分预测CLASS的影响，必须了解低需求的原因，LTCI如何改变治疗选择，以及LTCI如何影响系统成本。一个关键的，但值得注意的是被忽视的因素，在现有的实证研究长期购买一直是家庭结构和非正式护理的影响。对于政策规划来说，必须了解LTCI购买和家庭结构如何相互作用，因为潜在非正式护理的存在可能会使精算定价公平甚至补贴的LTCI计划对许多潜在买家失去吸引力。此外，LTCI和家庭结构可能以重要的方式相互作用，影响LTC的使用，成本和LTCI市场扩张的努力。为了填补证据基础中的这一关键空白，我们将使用定性和定量方法相结合的方法。焦点小组与老年人，我们将探讨家庭关系如何影响偏好的长期信托和市场购买的长期保险。与成年子女的焦点小组将提供如何提供非正式护理的态度和偏好的变化与父母的LTCI覆盖的见解。除了提供定量的结果，定性的方法将允许一个迄今为止无法测试的有效性假设经济学家通常在这一领域，即存在的家庭间的道德风险，以及是否文化规范，孝道，独立的愿望，或遗赠动机占主导地位。第二，我们将探讨家庭结构对购买长期护理保险的影响，使用健康和退休研究（HRS），唯一的全国代表性数据集，包括LTCI沿着与家庭结构的全面和动态的措施，反映现代生活的一致问题。为了识别异质性的影响，并最大限度地适用于LTCI扩展的努力，如类，我们将专注于家庭结构的相互作用与财富，收入和其他重要属性。第三，我们将使用HRS来检查LTCI对长期护理使用的期望和轨迹的影响。我们将研究LTCI是否改变残疾发作和使用长期护理类型之间的时间，不同类型的LTC随着时间的推移访问的顺序，以及在任何LTC状态下花费的时间。公共LTC成本的影响将使用我们的研究结果和成本数据从文献中模拟。

DESCRIPTION (provided by applicant): Family Structure, Informal Care, and Long-term Care Insurance Long-term care (LTC) is one of the biggest financial risks facing the elderly today yet very few people-13 percent of current 65 year olds-insure against the risk of self-financing LTC. This lack of insurance coverage has spurred public policy into action, with over half of all States offering tax breaks for private LTC insurance (LTCI) purchases as of 2008. However, LTCI purchases have remained recalcitrant to policy change thus far, with neither substantial increase in coverage nor cost savings to Medicaid. The recent passage of the Community Living and Supported Services Act (CLASS) is the most sweeping change to the LTCI market to date. However, to adequately predict the impact of CLASS, one must understand the causes of low demand, how having LTCI changes one's treatment choices, and how LTCI thus impacts costs to the system. A crucial but notably overlooked factor in existing empirical studies of LTCI purchases has been the influence of family structure and the availability of informal care. It is imperative to understand how LTCI purchases and family structure interact for policy planning, because the presence of potential informal care may make actuarially fairly priced or even subsidized LTCI plans unattractive to many potential buyers. Furthermore, LTCI and family structure may interact in important ways to affect LTC use, costs, and LTCI market expansion efforts. To fill this critical gap in the evidence base, we will use a combination of qualitative and quantitative methods. Focus groups with older adults we will explore how familial relationships influence preferences for LTC and market purchases of LTCI. Focus groups with adult children will provide insight on how attitudes and preferences to provide informal care change with a parent's LTCI coverage. In addition to informing the quantitative results, the qualitative approach will allow a heretofore unavailable test of the validity of the assumptions economists commonly make in this area-namely, the existence of interfamily moral hazard, and whether cultural norms, filial piety, desires for independence, or bequest motives dominate. Second, we will explore the effect family structure has on the purchase of long-term care insurance using the Health and Retirement Study (HRS), the only nationally representative data set to include consistent questions on LTCI along with comprehensive and dynamic measures of family structure that reflect modern life. To identify heterogeneity of effects and maximize applicability to LTCI expansion efforts such as CLASS, we will focus on family structure's interactions with wealth, income, and other important attributes. Third, we will use the HRS to examine what effect LTCI has on expectations about and trajectories of long-term care use. We will examine whether LTCI alters time elapsed between onset of disability and use of long-term care by type, the order in which distinct types of LTC are accessed over time, and the duration of time spent in any LTC state. Implications for public LTC costs will be simulated using our results and cost data from the literature.