Cohen M A, Tell E J, Wallack S S
Med Care. 1986 Dec;24(12):1161-72. doi: 10.1097/00005650-198612000-00008.
In this paper, we estimate the risk of an individual of entering a nursing home throughout the aging process. We then estimate the expected lifetime costs of nursing home use both for an individual and for society as a whole. The model is based on double-decrement life-table analysis. Data are taken from a 1977 survey of 4,400 Medicare beneficiaries. At age 65, the upper bound for the lifetime risk of entering a nursing home is 43.1%. The risk of entering a nursing home increases with age until around age 80. At about age 85, the risk begins to decline significantly. At almost all ages, the lifetime risk of entry for females is twice that of males. The expected lifetime costs of nursing home care across all ages are between $10,500 and $13,600. These costs are distributed very unequally. Only 13% of the elderly account for 90% of all nursing home expenditures. Given current life expectancy, the expected annual cost per person over age 65 is between $532 and $760. In the year 2000, the expected annual average costs of nursing home care per elderly person will range from $450 to $650. The decline in the average annual cost per person reflects shifts in the age structure and increased life expectancy. These figures need not represent an unmanageable burden on society's resources. Figures presented here help establish the feasibility and desirability of long-term care risk-sharing arrangements among the elderly, like long-term care insurance, life care communities, and other models.
在本文中，我们估计了个体在整个衰老过程中进入养老院的风险。然后，我们估计了个体以及整个社会使用养老院的预期终身成本。该模型基于双减量生命表分析。数据取自1977年对4400名医疗保险受益人的调查。65岁时，进入养老院的终身风险上限为43.1%。进入养老院的风险随年龄增长而增加，直到80岁左右。大约在85岁时，风险开始显著下降。几乎在所有年龄段，女性进入养老院的终身风险都是男性的两倍。所有年龄段养老院护理的预期终身成本在10500美元至13600美元之间。这些成本分布极不均衡。只有13%的老年人占所有养老院支出的90%。按照目前的预期寿命，65岁以上人群的人均预期年度成本在532美元至760美元之间。到2000年，每位老年人养老院护理的预期年度平均成本将在450美元至650美元之间。人均年度成本的下降反映了年龄结构的变化和预期寿命的增加。这些数字不一定代表对社会资源造成难以承受的负担。这里给出的数字有助于确定老年人之间长期护理风险分担安排的可行性和可取性，如长期护理保险、生活护理社区及其他模式。
