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无形的转变:伙伴长期护理保险如何影响老年人的护理工作

The Unseen Shift: How Partnership Long-term Care Insurance Influences Caregiving Among Older Adults.

作者信息

Zai Xianhua

机构信息

Department of Labor Demography, Max Planck Institute for Demographic Research, Rostock, Germany.

Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany/Helsinki, Finland.

出版信息

J Gerontol B Psychol Sci Soc Sci. 2024 Dec 1;79(12). doi: 10.1093/geronb/gbae168.

Abstract

OBJECTIVES

Although the partnership long-term care insurance (PLTC) program was designed to mitigate the low uptake of long-term care insurance (LTCI) and reduce Medicaid's financial burden, research has predominantly focused on its direct impacts, leaving the effects on informal caregiving unexplored. This study aimed to investigate how the program alters the dynamics of family-provided care, leveraging nationally representative data to unveil the broader consequences of informal caregiving arrangements among older individuals.

METHODS

Data for this study were sourced from the U.S. Health and Retirement Study (1992-2018) and linked with the timing of the PLTC program implementation across states. The analysis compared individuals exposed to the program with those who were not, employing 2-way-fixed-effects and dynamic models to assess its impact on LTCI coverage and reliance on informal caregiving.

RESULTS

The program positively affected LTCI coverage, increasing insurance uptake among older individuals in the long run. Conversely, a significant negative effect was observed on the receipt of assistance from any helper, indicating a reduced reliance on informal care. This reduction extended specifically to family helpers and children's assistance with activities of daily living. The analysis suggests that the program effectively reduced the necessity for informal caregiving across several domains.

DISCUSSION

These findings highlight the program's potential to reshape caregiving dynamics, suggesting the need for policies that balance promoting private insurance uptake with the implications for family caregiving roles. Policymakers should consider both the economic benefits and the social shifts induced by such programs in the long-term care landscape.

摘要

目标

尽管伙伴关系长期护理保险(PLTC)计划旨在缓解长期护理保险(LTCI)参保率低的问题并减轻医疗补助计划的财政负担,但研究主要集中在其直接影响上,而对非正式护理的影响尚未进行探讨。本研究旨在调查该计划如何改变家庭提供护理的动态,利用具有全国代表性的数据揭示老年人中非正式护理安排的更广泛后果。

方法

本研究的数据来自美国健康与退休研究(1992 - 2018年),并与各州PLTC计划实施的时间相关联。分析将接触该计划的个体与未接触该计划的个体进行比较,采用双向固定效应和动态模型来评估其对LTCI覆盖范围和对非正式护理依赖的影响。

结果

该计划对LTCI覆盖范围产生了积极影响,从长远来看提高了老年人的保险参保率。相反,观察到在接受任何帮助者的帮助方面存在显著的负面影响,这表明对非正式护理的依赖减少。这种减少尤其体现在家庭帮助者以及子女在日常生活活动方面的帮助上。分析表明,该计划在多个领域有效降低了对非正式护理的需求。

讨论

这些发现凸显了该计划重塑护理动态的潜力,表明需要制定政策来平衡促进私人保险参保与对家庭护理角色的影响。政策制定者应考虑此类计划在长期护理领域所带来的经济效益和社会转变。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b6de/11638482/15c40368d28c/gbae168_fig1.jpg

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