Rice J Bradford, Kasper Judith D, Pezzin Liliana E
Department of Economics, Boston University, Boston, MA 02215, USA.
Health Econ. 2009 Mar;18(3):275-90. doi: 10.1002/hec.1367.
Individuals with dual enrollment in Medicare and Medicaid have become the focus of heightened US federal and state policy interest in recent years. These beneficiaries are among the most vulnerable and costly persons served by either program. This analysis uses a reduced-form econometric model and a unique survey of community-resident dual enrollees to take a critical step toward understanding the relationships and combinations of state long-term care (LTC) policies and their relative effectiveness in achieving their intended effects: increasing access to care, improving activities of daily living/instrumental activities of daily living (ADL/IADL) assistance, and reducing unmet needs. We then simulate the effects of alternative policies to determine the most effective combination.The combination of policies that was most effective in reducing the percentage of individuals receiving low levels of assistance was high spending in the community relative to nursing home and low community LTC spending per recipient; that is, spending more on community care and spreading it across more people. Overall, this analysis confirms that Medicaid LTC policy decisions by states, and the combinations of policies that are implemented, result in important variations in levels of assistance to elderly persons with disabilities.
近年来，同时参加医疗保险和医疗补助计划的人群已成为美国联邦政府和州政府愈发关注的焦点。这些受益人群是这两个项目所服务的最脆弱且成本最高的人群之一。本分析采用简化形式的计量经济模型以及对社区居住的双重参保者进行的一项独特调查，朝着理解州长期护理（LTC）政策的关系与组合及其在实现预期效果方面的相对有效性迈出关键一步，这些预期效果包括：增加护理可及性、改善日常生活活动/工具性日常生活活动（ADL/IADL）协助以及减少未满足的需求。然后，我们模拟替代政策的效果以确定最有效的组合。在减少接受低水平协助的个体比例方面最有效的政策组合是，相对于疗养院，社区支出较高且每位受助者的社区长期护理支出较低；也就是说，在社区护理上投入更多资金并惠及更多人群。总体而言，本分析证实，各州的医疗补助长期护理政策决策以及所实施的政策组合，导致对残疾老年人的协助水平存在重大差异。
