Estimating the Demand for Medicaid Financial Long-Term Care for the Elderly

描述(申请人提供)：本K01奖项的申请是为了促进ArPita Chattopadhyay博士向老龄化和长期护理流行病学领域的独立研究员过渡，重点是医疗补助政策。她的长期目标是开发一个跨学科的项目，将关于衰老和残疾的生物医学研究与经济学和社会学的行为研究联系起来，专注于老年人长期护理的利用和融资。培训目标是(1)获得老龄化和长期护理政策的社会学和经济学方面的实质性知识；(2)获得建立残疾随机模型的新技能；(3)制定一个框架，以估计残疾、长期护理使用和筹资的决定因素。指导团队包括经验丰富的卫生服务研究员安德鲁·宾德曼博士；长期护理问题专家罗伯特·纽科默博士和查琳·哈林顿博士；慢性病建模随机过程专家彼得·巴切蒂博士；以及专门研究老龄化人口统计学的罗纳德·李博士 种族和族裔构成的变化对长期护理的需求和利用医疗补助资助长期护理的影响尚未进行研究。这项研究将通过将种族和民族纳入老年人长期护理需求和医疗补助使用的预测模型来克服这一缺点。这项研究将涉及NIA的两个优先领域，即老龄化和卫生/医疗保健差距和卫生系统的效率。根据抽样调查和服务使用的行政来源的数据，本研究提出了四个具体目标，与未来长期护理使用和融资的四个结构性决定因素相对应。目标1将确定特定年龄残疾患病率的种族和族裔差异。目标2将确定特定年龄使用特定残疾程度的长期护理的种族和族裔差异。目标3将确定残疾老年人在使用医疗补助方面的种族和民族差异。然后，目标1-3将被组合并用于获得长期护理中的老年医疗补助受益人的随机预测(目标4)。在K01项目结束时，将为R01项目提出一个详细的微观模拟模型，其中包含使用医疗补助资助的长期护理的行为和结构决定因素。

DESCRIPTION (provided by applicant): This application for a K01 award is to facilitate Dr. Arpita Chattopadhyay's transition to an independent investigator in the field of epidemiology of aging and long-term care with a focus on Medicaid policy. Her long-term goal is to develop an interdisciplinary program linking biomedical research on aging and disability with behavioral research in economics and sociology that focuses on utilization and financing of long-term care among the elderly. The training goals are (1) to acquire substantive knowledge in sociology and economics of aging and long-term care policies; (2) to acquire new skills in developing stochastic models of disability; and (3) to develop a frame work for estimating the determinants of disability, long-term care use, and financing. The mentoring team includes Dr. Andrew Bindman, an experienced health services researcher; Drs. Robert Newcomer and Charlene Harrington, experts in long-term care issues; Dr. Peter Bacchetti, expert in stochastic processes in chronic disease modeling; and Dr. Ronal Lee, who specializes in the demography of aging The impact of changing racial and ethnic composition on the demand for long-term care and utilization of Medicaid for financing long-term care has not been studied. This research will overcome this shortcoming by incorporating race and ethnicity into projection models for long-term care demand and Medicaid use among the elderly. The research will address two of the priority areas at the NIA, namely aging and health /healthcare disparities and efficiency of the health system. Drawing upon data from sample surveys and administrative sources on service use, this research proposes four specific aims that correspond to four structural determinants of future long-term care use and financing. Aim 1 will determine racial and ethnic differences in age-specific prevalence of disability. Aim 2 will determine racial and ethnic differences in age specific use of long-term care for a given level of disability. Aim 3 will determine the racial and ethnic differences in use of Medicaid among the disabled elderly. Aims 1-3 will then be combined and used to obtain stochastic projection of elderly Medicaid beneficiaries in long-term care (Aim 4). A detailed microsimulation model incorporating behavioral and structural determinants of using Medicaid financed longterm care will be proposed for an R01 project at the end of the K01.