Wallack S S, Cohen M A
Bigel Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, Massachusetts 02254.
Ciba Found Symp. 1988;134:235-53. doi: 10.1002/9780470513583.ch16.
Long-term care costs will result in financial hardship for millions of elderly Americans and their families. The growing number of elderly people has focused public attention on the catastrophic problem of coverage for long-term care. Social insurance is unlikely to emerge as a solution in the USA. One reason is that the expected total cost is viewed as an unmanageable burden by both Federal and State governments. To others, it is the uncertainty surrounding the projected costs. This paper reports on the results of a double-decrement life-table analysis, based on a national survey of the elderly taken in early 1977 and one year later, that estimated the distribution and total lifetime nursing-home costs of the elderly. Combining the probability of nursing-home entry and length of stay, a 65-year-old faces a 43% chance of entering a nursing home and spending about +11,000 (1980 dollars). The distribution of lifetime costs is however very skewed with 13% of the elderly consuming 90% of the resources. Thus, while the costs of nursing-home care can be catastrophic for an individual, spread across a group they are not unmanageable. Given the distribution of income and assets among the elderly, a sizeable proportion could readily afford the necessary premiums of different emerging insurance and delivery programmes. Alternative private and public models of long-term care must be evaluated in terms of the goals of a finance and delivery system for long-term care.
长期护理费用将给数百万美国老年人及其家庭带来经济困难。老年人口数量的不断增加使公众将注意力集中在长期护理保障这一灾难性问题上。在美国，社会保险不太可能成为解决方案。一个原因是，联邦政府和州政府都认为预期的总成本是无法承受的负担。对其他人来说，是预计成本存在不确定性。本文报告了一项双重递减寿命表分析的结果，该分析基于1977年初对老年人进行的全国性调查以及一年后的调查，估计了老年人的养老院费用分布和终生总费用。综合考虑入住养老院的概率和住院时间，一名65岁的老人有43%的机会进入养老院并花费约11,000美元（1980年美元）。然而，终生费用的分布非常不均衡，13%的老年人消耗了90%的资源。因此，虽然养老院护理费用对个人来说可能是灾难性的，但在一个群体中分摊后并非无法承受。考虑到老年人的收入和资产分布情况，相当大比例的人能够轻松负担不同新兴保险和服务项目所需的保费。必须根据长期护理融资和服务系统的目标，对长期护理的替代私人和公共模式进行评估。
