Research Fellow, LeadingAge LTSS Center @UMass Boston, University of Massachusetts Boston, Boston, Massachusetts, USA.
Clinical Professor, Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA.
J Aging Soc Policy. 2023 May 4;35(3):343-359. doi: 10.1080/08959420.2020.1824538. Epub 2020 Sep 30.
With over fifteen million older adults in the United States relying on the means-tested Medicaid program for healthcare coverage, there has been concern over rising Medicaid costs among this rapidly growing age group. Few studies have longitudinally examined trends among older beneficiaries over time to identify factors related to Medicaid utilization and to better understand how potential coverage changes might impact this group. This study used the 1998 to 2014 waves of the Health and Retirement Study (N = 8,162) to analyze a representative sample of those aged 50 and older to ascertain demographic, health, and economic factors associated with Medicaid utilization over a sixteen-year period. The analyses showed stable probabilities of accessing the program over time and observed that the most vulnerable older adults make up the pool of Medicaid beneficiaries. There is no evidence of significant asset divestment in order to qualify for benefits. Multivariate analyses further revealed those who were older, female, minority race/ethnicity, less educated, in poorer health, below the federal poverty line, and with lower net wealth had a higher risk of utilizing Medicaid during the observed time period than their counterparts. Findings highlight the importance of monitoring changes in the documented risk factors over time in terms of their impact on Medicaid utilization and underscore the need to consider how these factors may be interrelated.
在美国，有超过 1500 万的老年人依赖于医疗补助计划（Medicaid）来获得医疗保障，因此人们一直担心这个快速增长的年龄群体的医疗补助成本会不断上升。很少有研究从纵向角度长期观察老年受益人的趋势，以确定与医疗补助利用相关的因素，并更好地了解潜在的覆盖范围变化可能如何影响这一群体。本研究使用了 1998 年至 2014 年的健康与退休研究（Health and Retirement Study，HRS）的调查数据（N=8162），分析了一个代表性的 50 岁及以上年龄组样本，以确定与 16 年间医疗补助利用相关的人口统计学、健康和经济因素。分析结果显示，在过去的时间里，该计划的参与概率一直保持稳定，而且最脆弱的老年人构成了医疗补助受益人的主要群体。没有证据表明为了获得福利而进行重大资产剥离。多元分析进一步表明，在观察期间，年龄较大、女性、少数族裔、受教育程度较低、健康状况较差、低于联邦贫困线、净资产较低的人比同龄人更有可能利用医疗补助。这些发现强调了随着时间的推移，监测记录的风险因素变化对医疗补助利用的影响的重要性，并突出了需要考虑这些因素如何相互关联的必要性。
