Moral Hazard and Long-Term Care Insurance

项目摘要 最近通过的《社区生活援助服务和支助法》， 医疗改革重新引起了人们对长期护理保险市场的关注， 给研究人员和政策制定者提出了许多未解之谜。尽管潜在的高成本， 长期护理和这些费用的倾斜分布，只有10%的老年人有长期护理 因此，保险公司对逆向选择和道德风险的关注比 典型的健康保险市场。虽然有限的研究机构已经开始取得进展， 了解长期护理保险市场和相关行为，逆向选择的程度， 道德风险在很大程度上仍不为人所知。不管CLASS的最终命运或形式如何， 长期护理使用的人口统计数据和政府预算的相关压力表明， 更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 额外使用可归因于长期护理保险的服务。现有研究 在医疗补助资助的疗养院使用的情况下，几乎没有发现道德风险的证据，但医疗补助- 受资助的疗养院使用可被认为是次优品。家庭保健和私人融资 疗养院的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。更广泛的 观点，包括所有疗养院的使用和特别有利的替代疗养院，如 为了充分掌握道德风险的程度，需要进行家庭护理。此外，最近的理论 工作已经重新审视了共同的假设，所有的道德风险是减少福利，而不是假设， 道德风险归因于收入效应是有效率的和福利改善，而道德风险归因于 价格效应仍然是低效和减少福利的。这种区别在长期内可能特别重要- 长期护理，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 健康与退休研究的一个长小组，以1）评估与健康相关的道德风险的总体程度， 长期护理保险覆盖范围，包括使用家庭护理; 2）解开估计的道德 道德风险分为收入效应引起的有效道德风险和价格效应引起的无效道德风险， 从而能够评估净福利效应; 3）进行政策模拟，以帮助 适当的福利设计。评估与长期护理保险相关的道德风险程度 覆盖面对于市场的财务可行性和可持续性、适当的福利设计以及 对一项公共政策（如CLASS）的总体福利影响的评估。

Project Summary 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% 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.