Snider S
EBRI Issue Brief. 1995 Jul(163):1-23.
Increased life expectancy and the aging of the baby boom generation will bring rapid growth in the number of people at risk of needing long-term care (LTC). This Issue Brief provides an overview of the current LTC financing and delivery system in the United States, focusing on private-sector initiatives to meet the United States' LTC needs. It discusses private-sector plan design--particularly employment-based plan design--providing an in-depth look at the dramatic changes taking place in the private-sector LTC market since its inception in the early and mid 1980s. Aside from informal care provided in the community, the current system of financing LTC depends largely on the Medicaid program and individual financing. Issues confronting this system include spiraling costs associated with LTC services that may threaten beneficiaries' access to care. Other issues include the potential depletion of personal assets and a bias toward institutionalization (which may not always provide the most cost-effective or desired type of care available). Many leaders regard private long-term care insurance (LTCI) as a way to increase access to financing and as a potential alternative to Medicaid and out-of-pocket financing. By the end of 1993, a total of 3.4 million private-sector LTCI policies had been sold, up from approximately 815,000 in 1987. While the majority of these plans were sold to individuals or through group associations, employment-based plans accounted for a significant proportion of this growth. Premiums for LTCI vary substantially based on age and plan design. Insurers generally attempt to set premiums such that they will remain level over the insured's lifetime. However, because little LTC claims insurance experience yet exists, the actuarial basis for developing premiums and statutory reserves is limited. Several bills over the last three Congresses have been introduced to address the issue of LTC. However, due to cost implications and lack of consensus regarding the optimum overall structure required to finance and deliver care, broad legislation to expand coverage--particularly public coverage--is not likely in the near term.
预期寿命的增加以及婴儿潮一代的老龄化将使需要长期护理（LTC）的风险人群数量迅速增长。本问题简报概述了美国当前的长期护理融资和服务提供体系，重点关注满足美国长期护理需求的私营部门举措。它讨论了私营部门计划的设计——特别是基于就业的计划设计——深入探讨了自20世纪80年代初至中期私营部门长期护理市场创立以来发生的巨大变化。除了社区提供的非正式护理外，当前的长期护理融资体系在很大程度上依赖医疗补助计划和个人融资。该体系面临的问题包括与长期护理服务相关的成本不断攀升，这可能威胁到受益人获得护理的机会。其他问题包括个人资产可能耗尽以及倾向于机构化护理（而机构化护理可能并不总是提供最具成本效益或最理想的护理类型）。许多领导人将私人长期护理保险（LTCI）视为增加融资渠道的一种方式，以及作为医疗补助和自掏腰包融资的潜在替代方案。到1993年底，共售出了340万份私营部门长期护理保险保单，而1987年约为81.5万份。虽然这些计划大多卖给了个人或通过团体协会销售，但基于就业的计划在这一增长中占了很大比例。长期护理保险的保费因年龄和计划设计而异。保险公司通常试图设定保费，使其在被保险人的一生中保持稳定。然而，由于长期护理理赔保险经验尚少，制定保费和法定准备金的精算基础有限。在过去三届国会期间，已经提出了几项法案来解决长期护理问题。然而，由于成本问题以及在为护理融资和提供护理所需的最佳总体结构方面缺乏共识，近期不太可能出台扩大覆盖范围——特别是公共覆盖范围——的广泛立法。
