TWO ASPECTS OF MEDICAID--ACUTE AND LONG-TERM CARE USAGE

现在，试图彻底改革医疗保健系统的努力已经失败， 零碎的联邦改革和州政府发起的改革将成为中心 舞台。一个主要令人担忧的领域是医疗补助的爆炸性增长 程序。改革的努力集中在医疗补助的两个主要方面， 对老年人的急性护理部分和长期护理。这 研究着眼于(1)以下情况对医疗服务利用的影响 符合条件的医疗补助对象从按服务收费(FFS)的医疗保健转变为 和(2)医疗补助补贴对 体弱多病老人入住养老院的决定及其作用 他们的成年子女在这个决定中。我们的目标是探索六个 具体问题，以告知政策制定者如何激励 政府建设的计划和交付系统会影响 医疗保健服务的利用率，因此方案成本。 第一个问题是评估计划对服务使用的影响 比如看医生和看诊所。该数据集具有独特的特点 FFS中登记的同一人的随机登记和观察 和预付的医疗补助计划。计数数据回归模型用于 显式说明用法的非负整数方面 变量。初步估计显示，医生人数没有显著变化 办公室就诊，但相对较昂贵的诊所使用，平均而言， 在一年中，每个人的访问量下降了大约一半。第二，数据用于 在FFS和预付费医疗补助中的人都允许估计 计划效果的分配，而不是简单的平均计划 对不同卫生保健使用水平的人的影响。一个 分配视角为政策制定者提供管理医疗服务的方式 影响医疗补助服务的高用户与低用户。第三，结果是 对比显示节目效果是否有显著差异 随着时间的推移，相同的人被观看时会出现，而观看不同的人时会出现 人们在某个时间点。主要的问题是如果有 人与人之间的潜在异质性足以削弱横截面 结果。 第四个问题涉及估计医疗补助补贴对 老年人进入养老院与留在养老院的决定 独立的或与他人同居的。数据来自专家小组的研究 《收入动态》1991年《家长健康补充资料》。初步结果不会 还包括政策变量，但它们符合预期 女性和残疾较多的人更有可能进入 养老院。第五，父母及其成年人的数据可用性 儿童使人们对生活与生活之间关系的估计成为可能 老年人成年子女的安排和劳动力供应。 这些估计将决定儿童在以下情况下的反应程度 他们的父母生病了，而这种应对的福利成本。六号 问题涉及估计非正式护理在多大程度上起到了 替代正式的长期护理。估计的好处在于 评估对诸如定期探视等廉价护理形式的需求 而不是昂贵的住院费用。

Now that the attempted overhaul of the health care system is dead, piecemeal federal reforms and state initiated reforms will take center stage. An area of major concern is the explosive growth of the Medicaid program. Reform efforts are focused on the two major aspects of Medicaid, the acute care component and long-term care for the elderly. This research looks at (1) the effect on medical service utilization when Medicaid eligibles are switched from fee-for-service (FFS) medical care to capitated health plans, and (2) the effect of Medicaid subsidies on the decision of the frail elderly to enter a nursing home, and the role of their adult children in the decision. The goal is to explore six specific issues in order to inform policy makers of how the incentive schemes and delivery systems constructed by the government affect utilization of medical care services and therefore program cost. The first issue is estimating the program effect on usage of services such as doctor and clinic visits. The data set uniquely features randomized enrollment and observations of the same people enrolled in FFS and prepaid Medicaid plans. Count data regression models are used to explicitly account for the nonnegative integer aspect of the usage variables. Preliminary estimates show no significant change in doctor office visits, but the relatively more costly use of clinics, on average, falls by roughly one-half a visit per person in a year. Second, data for people in both FFS and prepaid Medicaid allow for estimation of the distribution of the program effect rather than the simple mean program effect across people with different levels of health care use. A distributional perspective informs policy makers of how managed care affects high versus low users of Medicaid services. Third, results are compared to reveal if significant differences in the program effect emerge when the same people are viewed over time versus viewing different people at one point in time. The primary issue concerns if there is enough latent heterogeneity among people to weaken cross-sectional results. The fourth issue involves estimating the effect of Medicaid subsidies on the decision of the elderly to enter a nursing home versus remaining independent or living with others. The data come from the Panel Study of Income Dynamics 1991 Parent Health Supplement. Preliminary results do not yet include policy variables, but they conform to expectations in that women and people with more disabilities are more likely to enter a nursing home. Fifth, the availability of data for parents and their adult children makes possible estimation of the relationship between living arrangements and the labor supply of the adult children of the elderly. The estimates will determine the extent to which children respond when their parents are sick, and the welfare costs of such response. The sixth issue concerns estimating the extent to which informal care serves as a substitute for formal long-term care. The benefit of the estimates is in gauging the need for inexpensive forms of care such as a periodic visit from a nurse instead of expensive institutionalization.