Spillman B C, Kemper P
Division of Long Term Care Studies, Center for Intramural Research, Agency for Health Care Policy and Research, Bethesda, MD 20852.
Med Care. 1995 Mar;33(3):280-96. doi: 10.1097/00005650-199503000-00007.
Although much is known about who pays the annual aggregate nursing home bill, relatively little is known about payment-source patterns of individuals during their lifetimes. In this article, lifetime payment-source patterns are analyzed for elderly nursing home users, particularly the extent to which they spend down assets to become eligible for Medicaid. During their lifetimes, 44% of persons who use nursing homes after 65 years of age start and end as private payers, 27% start and end as recipients of Medicaid benefits, and 14% spend down assets to become eligible for Medicaid benefits. Although still a relatively small proportion, the asset spend-down estimate based on lifetime data is 2.5 times previous national estimates based on data for single nursing home stays. The projected risk of spending down assets in nursing homes for all persons who turn 65 years of age in 1995, including users and nonusers of nursing homes, is slightly more than 6%. Equally or more important for policy is that 17% of all persons who turn 65 years of age can expect to end up using a nursing home and receiving Medicaid reimbursement. Of those, more than 3 in 5 will have entered the nursing home already eligible for Medicaid benefits.
尽管对于谁支付年度疗养院总费用已有很多了解，但对于个人一生中的支付来源模式却知之甚少。在本文中，分析了老年疗养院使用者一生中的支付来源模式，特别是他们为符合医疗补助资格而耗尽资产的程度。在他们的一生中，65岁以后使用疗养院的人中，44%从开始到结束都是自费者，27%从开始到结束都是医疗补助福利的受益者，14%耗尽资产以符合医疗补助福利资格。尽管这一比例仍然相对较小，但基于终生数据的资产耗尽估计是此前基于单次疗养院住院数据的全国估计的2.5倍。1995年所有年满65岁的人，包括疗养院使用者和非使用者，在疗养院耗尽资产的预计风险略高于6%。对政策而言同样或更重要的是，所有年满65岁的人中有17%预计最终会使用疗养院并获得医疗补助报销。其中，五分之三以上的人进入疗养院时就已经符合医疗补助福利资格。
