Burwell B O, Adams E K, Meiners M R
SysteMetrics/McGraw-Hill, Lexington, MA 02173.
Med Care. 1990 Apr;28(4):349-62. doi: 10.1097/00005650-199004000-00006.
Many elderly persons enter nursing homes as private pay clients, spend their available life savings, and then apply for medical assistance under Medicaid after their assets are depleted. However, reliable data on the size and characteristics of this "spend-down" population have been lacking. This study used Medicaid claims and enrollment data to identify the proportion of elderly Medicaid nursing-home users who originally entered nursing homes as private pay clients versus those eligible for Medicaid before or concurrent with, their nursing-home admission. The study population consisted of all elderly nursing-home users receiving Medicaid in Michigan in 1984, a total of 36,898 unduplicated recipients. Findings indicated that "spend-downers" comprised 27.2% of all elderly users. Once on Medicaid, spend downers exhibited similar nursing-home utilization patterns as other groups, but incurred lower Medicaid claims because they contributed more to the cost of their nursing-home care. In aggregate, the State of Michigan Medicaid program spent $75.4 million on nursing-home services in 1984 for elderly persons who spent down to eligibility in a nursing home. These data are relevant to state policy initiatives to reduce Medicaid spending for nursing-home care by encouraging potential spend downers to purchase long-term care insurance.
许多老年人以自费客户的身份进入养老院，花光他们现有的积蓄，然后在资产耗尽后申请医疗补助。然而，一直缺乏关于这个“消费后符合资格”群体规模和特征的可靠数据。本研究使用医疗补助报销和登记数据，来确定最初以自费客户身份进入养老院的老年医疗补助养老院使用者的比例，以及那些在入住养老院之前或同时就符合医疗补助资格的使用者的比例。研究对象包括1984年在密歇根州接受医疗补助的所有老年养老院使用者，共有36,898名非重复接受者。研究结果表明，“消费后符合资格者”占所有老年使用者的27.2%。一旦符合医疗补助条件，消费后符合资格者与其他群体表现出相似的养老院使用模式，但医疗补助报销费用较低，因为他们为自己的养老院护理费用贡献了更多。总体而言，1984年密歇根州医疗补助计划为那些在养老院消费后符合资格的老年人的养老院服务支出了7540万美元。这些数据与州政策倡议相关，该倡议旨在通过鼓励潜在的消费后符合资格者购买长期护理保险，来减少医疗补助在养老院护理方面的支出。
