Moral Hazard and Long-Term Care Insurance

道德风险和长期护理保险

• 批准号: 8332824
• 负责人: RITA TAMARA KONETZKA
• 金额: $ 26.3万
• 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/8332824
• 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

Project Summary 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% 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.

项目摘要 社区生活援助服务和支持（班级）的最新通过作为 健康改革引起了人们对长期护理保险市场的重新关注，这个市场长期很长 向研究人员和政策制定者提出了许多未解决的问题。尽管成本可能很高 长期护理和这些费用的偏差分配，只有10％的老年人有长期护理 因此，保险公司和保险公司对不利选择和道德危害表达了比 在典型的健康保险市场中。虽然有限的研究已经开始取得进展 了解长期护理保险市场和相关行为，不利选择的程度 道德危害在很大程度上仍然未知。无论最终的命运或班级的形式如何 长期护理使用以及政府预算的相关压力的人口统计指出， 更迫切需要回答这些问题。一个特别研究的地区是道德危害，或 可以归因于长期护理保险范围的服务的额外使用。现有研究 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 养老院的使用可能被认为是劣等的好处。家庭卫生保健和私人资助 疗养院的使用可能是普通商品，因此更有可能遭受道德危害。更广泛 观点，包括所有疗养院的使用，尤其是疗养院的替代品，例如 为了充分捕获道德危害的程度，需要家庭护理。此外，最近的理论 工作重新审视了所有道德危害都在减少福利的普遍假设，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，而道德危害则归因于 价格影响仍然效率低下和降低福利。这种区别在长期中可能尤其重要 术语护理，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 健康和退休研究的长小组至1）评估与道德危害相关的总体范围 具有长期护理保险范围，包括使用家庭护理； 2）解开估计的道德 由于价格效应造成收入效应和效率低下的道德危害，危害有效的道德危害，由于价格效应， 从而评估净福利效应； 3）进行政策模拟以帮助 适当的好处设计。评估与长期护理保险相关的道德危害程度 覆盖范围对于市场的财务生存能力和可持续性至关重要 评估公共政策（例如阶级）的整体福利效应。