LONGEVITY AND ELDERLY HEALTH CARE EXPENDITURES

描述（改编自申请人的摘要）： 预计未来几十年美国人口将有深刻的变化。 对总体医疗保健成本的影响。预计医疗保健费用将 因为婴儿潮一代将增加老年人的数量， 支出一般随着年龄的增长而增加，老年人的寿命更长， 技术变革如果继续下去， 以历史速度增长。然而，有四个因素可以缓解这个问题。 医疗保健支出部分取决于死亡前的时间， 因此，寿命的延长可能只是推动了 未来的支出。越来越多的医疗保险 受益人正在参加医疗保险管理的医疗保健，这可能会减缓增长 的支出。男性寿命的增长速度快于女性， 这意味着更少的老年人丧偶，这是一个主要的风险因素， 昂贵的长期护理。最后，残疾率一直在下降， 至少在过去十年。 在研究的第一部分，研究人员将分析每人每年 医疗保健支出作为年龄，死亡时间， 相互作用，保险（FFS与HMO），功能状态（ADL和IADL），以及 使用七年的医疗保险当前受益人调查的人口统计数据。的 分析将集中于所有支付长者医疗服务的人士的整体医疗开支 医疗保险受益人，标准服务费和HMO 受益人。他们还将研究三种具体类型的支出： 住院治疗、家庭保健和疗养院。付款人类型包括 医疗保险、医疗补助、自付和其他支付者。 在研究的第二部分，他们将模拟未来的医疗保健 通过将我们的经验结果与现有的估计相结合， 关键参数的变化--死亡率、功能状态、其他 人口统计学、保险和技术变革。MCBS面板数据将 使他们能够使用自己对管理式医疗覆盖率增长的估计， 残疾率的下降以及其他来源。

DESCRIPTION (Adapted from the Applicant's Abstract): Rapid aging by the United States population over the next several decades is expected to have profound effects on aggregate health care costs. Health care costs are expected to increase because babyboomers will swell the number of elderly, health care expenditures generally increase with age, the elderly are living longer, and technological change will increase the cost of medicine if it continues to increase at historical rates. However, four factors may mitigate the problem. Health care expenditures depend in part on time until death, with higher expenditures prior to death, so increased longevity may merely push expenditures further into the future. A growing percentage of Medicare beneficiaries are enrolling in Medicare managed care, which may slow the growth of expenditures. Male longevity has increased faster than female longevity, meaning that fewer elderly are widowed, which is a major risk factor for expensive long-term care. Finally, disability rates have been declining over at least the last decade. In the first part of the study the investigators will analyze per person annual health care expenditures as a function of age, time until death, their interaction, insurance (FFS vs. HMO), functional status (ADLs and IADLs), and demographics using seven years of the Medicare Current Beneficiary Survey. The analysis will focus on total health care expenditures by all payers for elderly Medicare beneficiaries, for both standard fee-for-service and HMO beneficiaries. They will also look at three specific types of expenditures: inpatient hospital care, home health, and nursing home. Payer types include Medicare, Medicaid, out-of-pocket, and other payers. In the second part of the study they will simulate future health care expenditures by combining our empirical results with available estimates of changes in the key parameters--mortality, functional status, other demographics, insurance, and technological change. The MCBS panel data will enable them to use their own estimates of the increase in managed care coverage and the decrease in disability rates, as well as other sources.