MEDICAL CARE OF THE DISABLED ELDERLY

老年人医疗保健方面的公共支出正以无情的速度增长。本子项目将研究残疾老年人在这一支出增长中的作用，认识到这一群体的命运对医疗保险和医疗补助费用产生不成比例的影响，因为他们比非残疾老年人更倾向于需要住院和强化治疗。了解老年人口残疾的演变，以及特殊残疾如何与慢性病和医疗需求相互作用，是预测这一高成本群体未来保健支出所需的重要知识来源。为了发展这方面的知识，该子项目将侧重于以下具体目标：(1)综合我们对残疾趋势的理解，(2)建立残疾和慢性病之间的跨期联系，(3)检查残疾和慢性病死亡率的演变，(4)建立与医疗保险/医疗补助支出和残疾有关的终身概况，以及(5)提供评估政策改革影响的能力。为了进行这项全面的研究，该子项目将利用各种各样的老年人调查数据源，结合从医疗保险和医疗补助登记和索赔数据中构建的复杂纵向文件，详细说明医疗服务的成本和使用情况。我们的实证工作将依赖于两个基本的实证框架，能够总结事件和支出如何随时间和年龄变化：“队列”概况描述特定群体的结果或支出分布如何随时间和年龄变化；在纵向环境中对个人的动态分位数进行估计，揭示了一生中健康状况和支出的持续程度。

Public expenditures on health care for the elderly are rising at a relentless rate. This subproject will study the role of the disabled elderly in this expenditure growth, recognizing that the fate of this group has a disproportionate impact on Medicare and Medicaid expenses due to their greater tendency to require hospitalization and intensive medical treatments than their non-disabled counterparts. Learning about the evolution of disabilities in the elderly population in conjunction with how particular disabilities interplay with chronic illnesses and medical needs constitutes a vital source of knowledge required to project future health-care expenditures by this high cost group. To develop this knowledge, this subproject will focus on the following specific aims: (1) synthesize our understanding of trends in disability, (2) establish the intertemporal links between disabilities and chronic illnesses, (3) examine evolution of mortality rates for disabilities and chronic diseases, (4) develop lifetime profiles relating Medicare/Medicaid expenditures and disabilities, and (5) provide a capacity for evaluating implications of policy reforms. To conduct this comprehensive study, this subproject will exploit a wide variety of survey data sources on the elderly, in combination with sophisticated longitudinal files constructed from Medicare and Medicaid enrollment and claims data detailing costs and use of medical services. Our empirical work will rely on two basic empirical frameworks capable of summarizing how events and expenditures evolve over time and across ages: "cohort" profiles characterizing how outcomes or expenditure distributions change over time and across ages for specific groups; and the estimation of dynamic quantiles for individuals in a longitudinal setting revealing the degree of the persistence in health conditions and expenditures over a lifetime.