Moral Hazard and Long-Term Care Insurance

道德风险和长期护理保险

• 批准号: 8212739
• 负责人: RITA TAMARA KONETZKA
• 金额: $ 29.1万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8212739
• 关键词: Accounting; Address; Adult; Age; Area; Attention; Behavior; Belief; Budgets; Communities; Data; Disability Insurance; Elderly; Government; Health; Health Insurance; Healthcare; Home Care Services; Home Nursing Care; Home environment; Income; Individual; Inferior; Insurance; Insurance Carriers; Insurance Coverage; Literature; Long-Term Care; Long-Term Care Insurance; Marketing; Medicaid; Methods; Minority; Morals; Nature; Nursing Homes; Policies; Policy Developments; Population; Price; Public Policy; Relative (related person); Research; Research Personnel; Retirement; Running; Services; Social Welfare; Solutions; System; Work; base; community based service; community living; consumer behavior; cost; demographics; design; evidence base; exhaust; hazard; improved; patient home care; service utilization; simulation

DESCRIPTION (provided by applicant): Recent passage of the Community Living Assistance Services and Supports (CLASS) Act as part of health reform has drawn renewed attention to the long-term care insurance market, a market which has long presented many unanswered questions to researchers and policymakers. Despite the potentially high cost of long-term care and the skewed distribution of those costs, only 10 percent of elderly adults have long-term care insurance, and insurers consequently express greater concern about adverse selection and moral hazard than in typical health insurance markets. While a limited body of research has begun to make progress in understanding long-term care insurance markets and associated behavior, the extent of adverse selection and moral hazard remain largely unknown. Regardless of the eventual fate or form of CLASS, the projected demographics of long-term care use and the associated strain on government budgets point to a more and more urgent need to answer these questions. A particularly under-researched area is that of moral hazard, or the additional use of services that can be attributed to long-term care insurance coverage. Existing research finds little evidence for moral hazard in the case of Medicaid-financed nursing home use, but Medicaid- financed nursing home use may be considered an inferior good. Home health care and privately financed nursing home use may be normal goods and thus more likely to be subject to moral hazard. A broader perspective, including all nursing home use and especially favorable alternatives to nursing homes, such as home care, is required in order to capture fully the extent of moral hazard. Furthermore, recent theoretical work has revisited the common assumption that all moral hazard is welfare-reducing, positing instead that moral hazard attributable to income effects is efficient and welfare-improving while moral hazard attributable to price effects remains inefficient and welfare-reducing. This distinction may be particularly important in long- term care, an area of health care in which public payers currently dominate. In this project, we propose to use a long panel of the Health and Retirement Study to 1) assess the overall extent of moral hazard associated with long-term care insurance coverage, including use of home care; 2) disentangle the estimated moral hazard into efficient moral hazard due to the income effect and inefficient moral hazard due to the price effect, thereby enabling an assessment of the net welfare effect; and 3) conduct policy simulations to aid in appropriate benefit design. Assessing the extent of moral hazard associated with long-term care insurance coverage is essential to financial viability and sustainability of the market, to appropriate benefit design, and to an assessment of the overall welfare effects of a public policy such as CLASS. PUBLIC HEALTH RELEVANCE: Reasonable solutions to the financing of long-term care have long eluded policymakers and this challenge promises to increase in importance as the population ages. This project proposes to investigate the extent and nature of long-term care utilization in the presence of insurance coverage, research that is essential to financial viability and sustainability of the long-term care insurance market, to appropriate benefit design, and to an assessment of the overall welfare effects of a public policies designed to address long-term care financing.

描述（由申请人提供）：作为卫生改革的一部分，社区生活援助服务和支持的最新通过已引起人们对长期护理保险市场的关注，长期护理保险市场长期以来向研究人员和政策制定者提出了许多未解决的问题。尽管长期护理的成本可能很高，并且这些成本的分配偏差，但只有10％的老年人拥有长期护理保险，因此保险公司比典型的健康保险市场对不利选择和道德危害表达了更大的关注。尽管有限的研究已经开始在理解长期护理保险市场和相关行为方面取得进展，但不利选择和道德危害的程度仍然很大。不管最终的命运或阶级形式如何，对长期护理使用的预计人口统计以及政府预算的相关压力表明，越来越迫切需要回答这些问题。一个特别不足的领域是道德危害，或其他可以归因于长期护理保险范围的服务。现有的研究发现，在医疗补助资助的疗养院使用的情况下，几乎没有证据表明道德危险，但医疗补助融资的疗养院使用可能被认为是劣等的好处。家庭医疗保健和私人资助的疗养院使用可能是普通商品，因此更有可能遭受道德危害。为了充分捕获道德危险的程度，需要更广泛的观点，包括所有疗养院使用，尤其是疗养院的替代品，例如家庭护理。此外，最近的理论工作重新审查了一个共同的假设，即所有道德危害都在降低福利，而是认为，归因于收入效应的道德危害是有效的，福利改善的，而归因于价格效应的道德危害仍然保持效率和福利降低。这种区别在长期护理中尤其重要，这是公共付款人目前主导的医疗保健领域。在这个项目中，我们建议使用长期的健康和退休研究小组进行1）评估与长期护理保险范围相关的道德危害的总体范围，包括使用家庭护理； 2）将估计的道德危害置于有效的道德危害中，这是由于收入效应和由于价格效应而效率低下的道德危害，从而评估了净福利效应； 3）进行政策模拟以帮助进行适当的利益设计。评估与长期护理保险相关的道德危害程度对于市场的财务生存能力和可持续性，适当的利益设计以及评估公共政策（例如班级）的整体福利效应至关重要。 公共卫生相关性：长期护理融资的合理解决方案长期以来一直避免了决策者，这一挑战有望随着人口年龄的增长而提高重要性。该项目建议在存在保险范围的情况下研究长期护理利用的程度和性质，这对于长期护理保险市场的财务可行性和可持续性至关重要，以评估旨在解决长期护理融资的公共政策的整体福利效应。