Arling G, Hagan S, Buhaug H
Center for Health Systems Research and Analysis, University of Wisconsin, Madison 53706.
Med Care. 1992 Aug;30(8):699-717. doi: 10.1097/00005650-199208000-00003.
In this study, the feasibility of a public-private long-term care (LTC) financing plan that would combine private LTC insurance with special Medicaid eligibility requirements was assessed. The plan would also raise the Medicaid asset limit from the current $2,000 to the value of an individual's insurance benefits. After using benefits the individual could enroll in Medicaid. Thus, insurance would substitute for asset spend-down, protecting individuals against catastrophic costs. This financing plan was analyzed through a computer model that simulated lifetime LTC use for a middle-income age cohort beginning at 65 years of age. LTC payments from Medicaid, personal income and assets, Medicare, and insurance were projected by the model. Assuming that LTC use and costs would not grow beyond current projections, the proposed plan would provide asset protection for the cohort without increasing Medicaid expenditures. In contrast, private insurance alone, with no change in Medicaid eligibility, would offer only limited asset protection. The results must be qualified, however, because even a modest increase in LTC cost growth or use of care (beyond current projections) could result in substantially higher Medicaid expenditures. Also, private insurance might increase personal LTC expenditures because of the added cost of insuring.
在本研究中，评估了一项公私合营长期护理（LTC）融资计划的可行性，该计划将私人长期护理保险与特殊医疗补助资格要求相结合。该计划还将把医疗补助资产限额从目前的2000美元提高到个人保险福利的价值。在使用福利后，个人可以加入医疗补助计划。因此，保险将替代资产消耗，保护个人免受灾难性费用的影响。通过一个计算机模型对该融资计划进行了分析，该模型模拟了从65岁开始的中等收入年龄队列的终身长期护理使用情况。该模型预测了医疗补助、个人收入和资产、医疗保险以及保险的长期护理支付情况。假设长期护理的使用和成本不会超过目前的预测，拟议的计划将为该队列提供资产保护，而不会增加医疗补助支出。相比之下，仅私人保险且医疗补助资格不变，只能提供有限的资产保护。然而，结果必须有所限定，因为即使长期护理成本增长或护理使用量有适度增加（超过目前的预测），也可能导致医疗补助支出大幅增加。此外，由于保险成本增加，私人保险可能会增加个人长期护理支出。
