Informal Care of Older Adults and Medicare Expenditures

老年人的非正式护理和医疗保险支出

• 批准号: 6660726
• 负责人: Courtney Harold Van Houtven
• 金额: $ 7.7万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6660726
• 关键词: Medicare /Medicaid; behavioral /social science research tag; caregivers; clinical research; cost effectiveness; data collection methodology /evaluation; extended care; extended care facility; geriatric nursing; health care cost /financing; health care policy; health care service evaluation; health care service utilization; health economics; health services research tag; home health care; hospital length of stay; hospital utilization; human old age (65+); human subject; mathematical model; nursing homes; patient care management

DESCRIPTION (provided by applicant): Informal care of the elderly by their adult children is a common form of long-term care, is often preferred by the elderly to formal care, and can reduce Medicare expenditures if it substitutes for formal care. While we know a great deal about informal caregivers, only recently have researchers quantified that informal care is a net substitute for long-term care. Little is known about how informal care affects Medicare expenditures, yet concerns about the solvency of the Medicare trust fund are escalating. Current projections by the Medicare Trustees show that the Medicare trust fund will be depleted in the year 2029 (CMS, 2001). This proposed study will determine whether the reductions in formal care from informal care lead to reductions in Medicare expenditures for home health, skilled nursing, and hospital use. Data uniquely suited to address questions of informal care and Medicare expenditures will be analyzed. The data are Medicare Claims merged with the Asset and Health Dynamics Among the Oldest-Old panel survey. The long panel data period (1992-2000) allows for a rich view of informal and formal care behavior for a nationally representative sample of adults age 70 and above, and requires use of longitudinal data analysis methods. In addition, the endogeneity of informal care in predicting expenditures requires the use of simultaneous equations methods. Instrumental variables (IV) estimation will be used to control for endogeneity, using child-level identifying instruments that have been used and validated in numerous studies. Two-part expenditure models will be used to model the expenditure behavior of the elderly for home health, skilled nursing, and hospital use. Informal care is important because it is the first line of defense for older adults who have faced a loss of independence. Ultimately informal care a effects the health status of the frail elderly, their ability to live independently, and expenditures on health care. Finding a relationship between informal care and Medicare expenditures would provide a strong impetus to examine Medicaid expenditures, would signal policymakers to include informal care supply changes in Medicare Trust fund projections, and would begin to inform the policy process about the cost-effectiveness of caregiver policies.

描述（由申请人提供）： 成年子女对老年人的非正式护理是长期护理的常见形式，通常比正式护理更受老年人青睐，并且如果替代正式护理，可以减少医疗保险支出。 虽然我们对非正式护理人员了解很多，但直到最近研究人员才量化非正式护理是长期护理的净替代品。人们对非正式护理如何影响医疗保险支出知之甚少，但人们对医疗保险信托基金偿付能力的担忧正在升级。医疗保险受托人目前的预测显示，医疗保险信托基金将在 2029 年耗尽（CMS，2001）。这项拟议的研究将确定非正式护理中正式护理的减少是否会导致家庭健康、熟练护理和医院使用的医疗保险支出减少。将分析特别适合解决非正式护理和医疗保险支出问题的数据。这些数据是医疗保险索赔与最年长者资产和健康动态小组调查合并而成的。 较长的面板数据周期（1992-2000）可以对全国代表性的 70 岁及以上成年人样本的非正式和正式护理行为有丰富的了解，并且需要使用纵向数据分析方法。此外，非正式护理在预测支出方面的内生性需要使用联立方程方法。工具变量（IV）估计将用于控制内生性，使用已在大量研究中使用和验证的儿童级别识别工具。将使用两部分支出模型来模拟老年人在家庭保健、专业护理和医院使用方面的支出行为。非正式护理很重要，因为它是失去独立的老年人的第一道防线。最终，非正式护理会影响体弱老年人的健康状况、独立生活的能力以及医疗保健支出。找到非正式护理和医疗保险支出之间的关系将为检查医疗补助支出提供强大的动力，将向政策制定者发出信号，将非正式护理供应的变化纳入医疗保险信托基金的预测中，并将开始向政策流程通报护理人员政策的成本效益。