NBER Center for Aging and Health Research

其他项目信息-项目摘要/摘要 认知衰退与健康保险决策和结果 这一行政补充申请提出了一个新的中心试点项目，作为 NBER老龄化和健康研究中心。该中心围绕着几项高优先级的研究而构建 通过网络会议和试点项目孵化和推进的主题。而NBER中心 不是针对阿尔茨海默氏症的拨款，阿尔茨海默氏症的经济学已经被中心领导人确定 作为新研究开发的几个高优先级主题之一。拟议的新试点研究探索了 认知功能下降，包括轻度认知障碍(MCI)、阿尔茨海默氏症的发病和进展 疾病和相关痴呆症(ADRD)与人们的医疗保险参保决定和随后的 结果。联邦医疗保险目前长期依赖于“有管理的竞争”方式来补充保险-- 定期护理、处方药和其他不包括在传统医疗保险中的保险。在这种方法中，私有的 保险公司在受监管的市场内争夺参保人。有些人，包括那些患有认知障碍的人 下降，可能难以驾驭这些市场，他们所做的招生决定可能反过来影响 其他健康后果。试点项目的具体目标是探索认知能力下降与以下几个方面的关系：(1) 健康保险的选择过程，包括医疗保险的承保范围和使用援助 投保决定；(2)保险计划投保中的惯性，定义为切换到以下计划的可能性 提供更大的风险保护或更低的成本；以及(3)联邦医疗保险D部分选择的结果，描述 每个人在他们选择的计划下都过得很好。这项研究将使用一个纵向数据库进行，跟踪 医疗保险受益人认知衰退的发生和进展；他们参加Medigap计划的情况， Medicare Part D处方药保险计划、Medicare Advantage计划、雇主赞助计划以及 提供长期护理覆盖范围的计划，包括医疗补助；以及许多其他医疗和医疗支出 措施。试点研究将提供初步结果，并支持方法论 根据此处描述的探索性分析直接开发更大的R01提案。

OTHER PROJECT INFORMATION – Project Summary/Abstract Cognitive Decline and Health Insurance Decisions and Outcomes This administrative supplement application proposes a new Center pilot project, to be conducted as part of the NBER Center for Aging and Health Research. The Center is structured around several high-priority research themes that are incubated and advanced through network meetings and pilot projects. While the NBER Center is not an Alzheimer’s-focused grant, the economics of Alzheimer’s disease has been identified by Center leaders as one of several high-priority themes for new research development. The proposed new pilot study explores how cognitive decline, including the onset and progression of mild cognitive impairment (MCI), Alzheimer’s disease, and related dementias (ADRD) relate to people’s health insurance enrollment decisions and subsequent outcomes. Medicare currently relies on a “managed competition” approach to supplemental insurance for long- term care, prescription drugs, and other coverage not included in traditional Medicare. In this approach, private insurers compete for enrollees within regulated markets. Some people, including those suffering from cognitive decline, may have difficulty navigating such markets, and the enrollment decisions they make may in turn affect other health outcomes. The specific aims of the pilot project are to explore how cognitive decline relates to: (1) the health insurance choice process, including the portfolio of coverage and use of assistance in making enrollment decisions; (2) inertia in insurance plan enrollment, defined as the likelihood of switching to plans that provide greater risk protection or lower costs; and (3) outcomes of Medicare Part D choices, describing how well each person fared under their chosen plan. The study will be conducted using a longitudinal database that tracks the onset and progression of cognitive decline among Medicare beneficiaries; their enrollment in Medigap plans, Medicare Part D prescription drug insurance plans, Medicare Advantage plans, employer-sponsored plans, and plans that provide long-term care coverage, including Medicaid; and many other health and health spending measures. The pilot research would provide the preliminary findings and support the methodological development for a larger R01 proposal that follows directly from the exploratory analyses described here.