A Prospective Model of Medicare Cost Trajectories

描述（由申请人提供）：近年来受到广泛关注的一个问题是年龄和死亡时间在决定医疗费用方面的相对重要性。众所周知，医疗保健费用在生命结束时急剧上升，特别是在死亡前一年。这导致许多人认为，人口老龄化，就其是预期寿命增加的结果而言，可能不会产生与医疗保险成本成比例的增长，因为与额外寿命相关的成本可能只是在以后的生活中经历。然而，所有关于年龄与死亡时间问题的研究都使用了一个模型，在这个模型中，根据测量的属性，有一个单一的人口水平的预期医疗保险成本路径。然而，有充分的理由假设，随着个人接近死亡，医疗保险成本有几种典型的平均路径。我们将建立一个短期医疗保险成本预测模型，该模型承认存在一组独特但未被观察到的成本轨迹类型。具体来说，该项目将：“估算死亡率和医疗保险成本的综合模型——包括总体和主要类别，如住院护理、门诊护理、SNF使用等——使用潜在级轨迹模型的概化，并应用来自国家长期护理调查和心血管健康研究的纵向数据，这两项数据都与连续的医疗保险索赔记录有关；”在控制诊断和选定的服务使用指标的同时，对年龄和死亡时间对保健费用的相对影响作出新的估计；以及“使用微观模拟来计算医疗保险总成本和部分成本的完整队列估计，对于分析中使用的两个数据文件创建的合成观察样本。”

DESCRIPTION (provided by applicant): An issue that has received a great deal of attention in recent years is the relative importance of age and time to death in determining health care costs. It is well-known that health care costs rise sharply at the end of life, especially in the year before death. This has led many to the view that population aging, insofar as it is a consequence of increased life expectancy, might not produce proportionate increases in Medicare costs, because the costs associated with the extra years lived may simply be experienced later in life. However, all studies of the age-versus-time-to-death question have used a model in which, conditional upon measured attributes, there is a single population-level pathway of expected Medicare costs. Yet there are strong reasons to suppose that there are several prototypical mean pathways of Medicare costs as individuals approach death. We will build a short-term Medicare-cost forecasting model that recognizes the existence of a set of distinctive, but unobserved, cost-trajectory types. Specifically, this project will: " Estimate an integrated model of mortality and Medicare costs-both in the aggregate and within major categories such as inpatient care, outpatient care, SNF usage and so on-using a generalization of latent-class trajectory models and applying longitudinal data from the National Long Term Care Survey and the Cardiovascular Health Study, both of which have been linked to continuous Medicare claims records; " Produce new estimates of the relative effects of age and time to death on health care costs, while controlling for diagnoses and selected service-use indicators; and " Use microsimulation to compute complete-cohort estimates of total and component Medicare costs, for samples of synthetic observations created from the 2 data files used in the analysis. PUBLIC HEALTH RELEVANCE: Medicare costs provide a measure of our commitment to maintaining and improving public health, as well as an index of our success in achieving public-health goals with respect to the nation's older citizens. Understanding the ways that ongoing changes in the population-greater longevity, a trend towards lower rates of disability at older ages, and the transition into late life of members of the "Baby Boom"-are likely to influence future Medicare costs is vital to our capacity to plan for the future. This project takes a new look at the question of whether age, or nearness to death, is mainly responsible for the observed patterns of Medicare costs that rise with age; the ultimate goal of the project is to produce improved means of forecasting future Medicare costs.