A Prospective Model of Medicare Cost Trajectories

描述(由申请人提供)：近年来受到极大关注的一个问题是年龄和死亡时间在确定医疗保健成本方面的相对重要性。众所周知，在生命的最后一年，特别是在死亡的前一年，医疗保健费用会急剧上升。这导致许多人认为，人口老龄化是预期寿命延长的结果，可能不会导致医疗保险成本按比例增加，因为与多活几年相关的成本可能只是在晚年经历。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，在该模型中，根据测量的属性，预期医疗保险成本只有一个总体水平的路径。然而，有充分的理由认为，随着个人濒临死亡，医疗保险成本存在几条典型的平均路径。我们将建立一个短期医疗保险成本预测模型，该模型认识到存在一组独特但未被观察到的成本轨迹类型。具体地说，这个项目将：“使用潜在类别轨迹模型的推广，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，估计死亡率和医疗保险成本的综合模型--包括总体上和住院护理、门诊护理、SNF使用等主要类别内的死亡率和医疗保险成本；”对年龄和死亡时间对医疗成本的相对影响进行新的估计，同时控制诊断和选定的服务使用指标；以及“使用微观模拟来计算根据分析中使用的2个数据文件创建的合成观察样本的医疗保险总成本和组成部分的完全队列估计。 与公共健康相关：医疗保险成本提供了一种衡量我们维护和改善公共健康的承诺的指标，也是我们在实现国家老年公民公共健康目标方面的成功指数。了解人口正在发生的变化--更长寿、老年伤残率下降的趋势，以及“婴儿潮”成员向晚年的过渡--可能会影响未来的医疗保险成本，这对我们规划未来的能力至关重要。该项目对年龄或接近死亡这一问题进行了新的审视，这一问题主要是对观察到的随着年龄增长的医疗保险成本模式负责；该项目的最终目标是改进预测未来医疗保险成本的方法。

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.