Family Structure, Informal Care and Long-term Care Insurance

描述（由申请人提供）：家庭结构、非正式护理和长期护理保险长期护理（LTC）是当今老年人面临的最大财务风险之一，但很少有人（目前65岁的人中只有13%）为自筹资金的长期护理风险投保。这种保险覆盖面的缺乏促使公共政策采取行动，截至2008年，超过一半的国家为私人购买LTCI保险提供税收减免。然而，到目前为止，LTCI的购买仍然不受政策变化的影响，既没有大幅增加覆盖范围，也没有为医疗补助节省成本。最近通过的《社区生活和支持服务法》（CLASS）是迄今为止LTCI市场最彻底的变化。然而，为了充分预测CLASS的影响，必须了解低需求的原因，LTCI如何改变一个人的治疗选择，以及LTCI如何影响系统的成本。在现有的LTCI购买实证研究中，一个至关重要但明显被忽视的因素是家庭结构和非正式护理的影响。必须了解LTCI购买和家庭结构如何相互作用，以便进行政策规划，因为潜在的非正式护理的存在可能使精算价格公平或甚至补贴的LTCI计划对许多潜在购买者没有吸引力。此外，LTCI和家族结构可能以重要的方式相互作用，影响LTCI的使用、成本和LTCI市场扩张的努力。为了填补证据基础上的这一关键空白，我们将使用定性和定量方法相结合的方法。以老年人为焦点小组，我们将探讨家庭关系如何影响长期消费偏好和长期消费的市场购买。与成年子女的焦点小组将深入了解父母提供非正式照顾的态度和偏好如何随着LTCI覆盖范围的变化而变化。除了为定量结果提供信息外，定性方法还将允许对经济学家在这一领域通常做出的假设的有效性进行迄今无法获得的检验——即，家庭间道德风险的存在，以及文化规范、孝道、独立愿望或遗产动机是否占主导地位。其次，我们将探索家庭结构对购买长期护理保险的影响，使用健康与退休研究（HRS），这是唯一具有全国代表性的数据集，包括关于LTCI的一致问题以及反映现代生活的家庭结构的全面和动态措施。为了确定影响的异质性，并最大限度地适用于LTCI扩展工作（如CLASS），我们将重点研究家庭结构与财富、收入和其他重要属性的相互作用。第三，我们将使用HRS来检查LTCI对长期护理使用的期望和轨迹的影响。我们将研究LTCI是否会改变残疾发作和使用长期护理之间的时间间隔，不同类型的LTC随时间的顺序，以及在任何LTC状态下花费的时间。将使用我们的结果和文献中的成本数据模拟对公共LTC成本的影响。

DESCRIPTION (provided by applicant): Family Structure, Informal Care, and Long-term Care Insurance Long-term care (LTC) is one of the biggest financial risks facing the elderly today yet very few people-13 percent of current 65 year olds-insure against the risk of self-financing LTC. This lack of insurance coverage has spurred public policy into action, with over half of all States offering tax breaks for private LTC insurance (LTCI) purchases as of 2008. However, LTCI purchases have remained recalcitrant to policy change thus far, with neither substantial increase in coverage nor cost savings to Medicaid. The recent passage of the Community Living and Supported Services Act (CLASS) is the most sweeping change to the LTCI market to date. However, to adequately predict the impact of CLASS, one must understand the causes of low demand, how having LTCI changes one's treatment choices, and how LTCI thus impacts costs to the system. A crucial but notably overlooked factor in existing empirical studies of LTCI purchases has been the influence of family structure and the availability of informal care. It is imperative to understand how LTCI purchases and family structure interact for policy planning, because the presence of potential informal care may make actuarially fairly priced or even subsidized LTCI plans unattractive to many potential buyers. Furthermore, LTCI and family structure may interact in important ways to affect LTC use, costs, and LTCI market expansion efforts. To fill this critical gap in the evidence base, we will use a combination of qualitative and quantitative methods. Focus groups with older adults we will explore how familial relationships influence preferences for LTC and market purchases of LTCI. Focus groups with adult children will provide insight on how attitudes and preferences to provide informal care change with a parent's LTCI coverage. In addition to informing the quantitative results, the qualitative approach will allow a heretofore unavailable test of the validity of the assumptions economists commonly make in this area-namely, the existence of interfamily moral hazard, and whether cultural norms, filial piety, desires for independence, or bequest motives dominate. Second, we will explore the effect family structure has on the purchase of long-term care insurance using the Health and Retirement Study (HRS), the only nationally representative data set to include consistent questions on LTCI along with comprehensive and dynamic measures of family structure that reflect modern life. To identify heterogeneity of effects and maximize applicability to LTCI expansion efforts such as CLASS, we will focus on family structure's interactions with wealth, income, and other important attributes. Third, we will use the HRS to examine what effect LTCI has on expectations about and trajectories of long-term care use. We will examine whether LTCI alters time elapsed between onset of disability and use of long-term care by type, the order in which distinct types of LTC are accessed over time, and the duration of time spent in any LTC state. Implications for public LTC costs will be simulated using our results and cost data from the literature.