@article {8684, title = {Racial and Ethnic Differences in End-of-Life Medicare Expenditures.}, journal = {Journal of the American Geriatrics Society}, volume = {64}, year = {2016}, pages = {1789-1797}, abstract = {

OBJECTIVES: To determine to what extent demographic, social support, socioeconomic, geographic, medical, and End-of-Life (EOL) planning factors explain racial and ethnic variation in Medicare spending during the last 6~months of life.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Decedents who participated in HRS between 1998 and 2012 and previously consented to survey linkage with Medicare claims (N~=~7,105).

MEASUREMENTS: Total Medicare expenditures in the last 180~days of life according to race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors, including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected.

RESULTS: The analysis included 5,548 (78.1\%) non-Hispanic white, 1,030 (14.5\%) non-Hispanic black, and 331 (4.7\%) Hispanic adults and 196 (2.8\%) adults of other race or ethnicity. Unadjusted results suggest that average EOL Medicare expenditures were $13,522 (35\%, P~<~.001) more for black decedents and $16,341 (42\%, P~<~.001) more for Hispanics than for whites. Controlling for demographic, socioeconomic, geographic, medical, and EOL-specific factors, the Medicare expenditure difference between groups fell to $8,047 (22\%, P~<~.001) more for black and $6,855 (19\%, P~<~.001) more for Hispanic decedents than expenditures for non-Hispanic whites. The expenditure differences between groups remained statistically significant in all models.

CONCLUSION: Individuals-level factors, including EOL planning factors do not fully explain racial and ethnic differences in Medicare spending in the last 6~months of life. Future research should focus on broader systemic, organizational, and provider-level factors to explain these differences.

}, keywords = {African Continental Ancestry Group, Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Cross-Cultural Comparison, Ethnic Groups, European Continental Ancestry Group, Female, Health Care Surveys, Health Expenditures, Hispanic Americans, Humans, Life Support Care, Longitudinal Studies, Male, Medicare, Rate Setting and Review, Social Support, Socioeconomic factors, Terminal Care, United States}, issn = {1532-5415}, doi = {10.1111/jgs.14263}, author = {Byhoff, Elena and Tamara B Harris and Kenneth M. Langa and Theodore J Iwashyna} } @article {7830, title = {Cognition and take-up of subsidized drug benefits by Medicare beneficiaries.}, journal = {JAMA Intern Med}, volume = {173}, year = {2013}, note = {Copyright - Copyright American Medical Association Jun 24, 2013 Last updated - 2013-07-12 SubjectsTermNotLitGenreText - United States--US}, month = {2013 Jun 24}, pages = {1100-7}, publisher = {173}, abstract = {

IMPORTANCE: Take-up of the Medicare Part D low-income subsidy (LIS) by eligible beneficiaries has been low despite the attractive drug coverage it offers at no cost to beneficiaries and outreach efforts by the Social Security Administration.

OBJECTIVE: To examine the role of beneficiaries{\textquoteright} cognitive abilities in explaining this puzzle.

DESIGN AND SETTING: Analysis of survey data from the nationally representative Health and Retirement Study.

PARTICIPANTS: Elderly Medicare beneficiaries who were likely eligible for the LIS, excluding Medicaid and Supplemental Security Income recipients who automatically receive the subsidy without applying.

MAIN OUTCOMES AND MEASURES: Using survey assessments of overall cognition and numeracy from 2006 to 2010, we examined how cognitive abilities were associated with self-reported Part D enrollment, awareness of the LIS, and application for the LIS. We also compared out-of-pocket drug spending and premium costs between LIS-eligible beneficiaries who did and did not report receipt of the LIS. Analyses were adjusted for sociodemographic characteristics, household income and assets, health status, and presence of chronic conditions.

RESULTS: Compared with LIS-eligible beneficiaries in the top quartile of overall cognition, those in the bottom quartile were significantly less likely to report Part D enrollment (adjusted rate, 63.5\% vs 52.0\%; P = .002), LIS awareness (58.3\% vs 33.3\%; P = .001), and LIS application (25.5\% vs 12.7\%; P < .001). Lower numeracy was also associated with lower rates of Part D enrollment (P = .03) and LIS application (P = .002). Reported receipt of the LIS was associated with significantly lower annual out-of-pocket drug spending (adjusted mean difference, -$256; P = .02) and premium costs (-$273; P = .02).

CONCLUSIONS AND RELEVANCE: Among Medicare beneficiaries likely eligible for the Part D LIS, poorer cognition and numeracy were associated with lower reported take-up. Current educational and outreach efforts encouraging LIS applications may not be sufficient for beneficiaries with limited abilities to process and respond to information. Additional policies may be needed to extend the financial protection conferred by the LIS to all eligible seniors.

}, keywords = {Cognition, Comprehension, Cost Sharing, Eligibility Determination, Health Care Surveys, Humans, Medicare, Medicare Part D, Poverty, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2013.845}, author = {Ifedayo Kuye and Richard G Frank and J. Michael McWilliams} } @article {10280, title = {Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries.}, journal = {Journal of Manipulative \& Physiological Therapeutics}, volume = {35}, year = {2012}, pages = {168-175}, abstract = {

OBJECTIVE: The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine.

METHODS: Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample.

RESULTS: There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9\% to 10.9\% over the 17-year period.

CONCLUSION: Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Chiropractic, Combined Modality Therapy, Episode of Care, Female, Geriatric Assessment, Health Care Surveys, Health Services, Humans, Incidence, Insurance Claim Reporting, Low Back Pain, Medicare Part B, Musculoskeletal Diseases, Primary Health Care, Retrospective Studies, Sex Factors, Treatment Outcome, United States}, issn = {1532-6586}, doi = {10.1016/j.jmpt.2012.01.011}, author = {Paula A Weigel and Jason Hockenberry and Suzanne E Bentler and Kaskie, Brian and Frederic D Wolinsky} } @article {7682, title = {Ethnic/race differences in the attrition of older American survey respondents: implications for health-related research.}, journal = {Health Serv Res}, volume = {47}, year = {2012}, month = {2012 Feb}, pages = {241-54}, publisher = {47}, abstract = {

OBJECTIVE: To compare models of attrition across race/ethnic groups of aging populations and discuss implications for health-related research.

DATA SOURCES: The Health and Retirement Study (1992-2008).

STUDY DESIGN: A competing risks model was estimated using a multinomial logit model when respondents faced competing types of risks, such as dying, being lost from the study, and nonresponse in some years for different groups of elderly. Key explanatory variables were foreign birth, health insurance, and health status.

PRINCIPAL FINDINGS: Variables describing foreign birth, health insurance, and health status differed in their prediction of attrition across ethnic groups of aging populations.

CONCLUSIONS: Differences in the predictors of attrition across ethnic groups of elderly could potentially lead to biased estimates in health-related research using longitudinal data sources.

}, keywords = {Bias, ethnicity, Female, Health Care Surveys, Health Services Research, Health Surveys, Hispanic or Latino, Humans, Male, Mexican Americans, Middle Aged, Racial Groups, Risk, Socioeconomic factors, United States}, issn = {1475-6773}, doi = {10.1111/j.1475-6773.2011.01322.x}, author = {Natalia A. Zhivan and Alfonso Ang and Hortensia Amaro and William A. Vega and Kyriakos S Markides} } @article {7758, title = {Health service use among the previously uninsured: is subsidized health insurance enough?}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Oct}, pages = {1155-68}, publisher = {21}, abstract = {

Although it has been shown that gaining Medicare coverage at age 65 years increases health service use among the uninsured, difficulty in changing habits or differences in the characteristics of previously uninsured compared with insured individuals may mean that the previously uninsured continue to use the healthcare system differently from others. This study uses Medicare claims data linked to two different surveys--the National Health Interview Survey and the Health and Retirement Study--to describe the relationship between insurance status before age 65 years and the use of Medicare-covered services beginning at age 65 years. Although we do not find statistically significant differences in Medicare expenditures or in the number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 years continue to use the healthcare system differently from those who were privately insured. Specifically, they have 16\% fewer visits to office-based physicians but make 18\% and 43\% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured seem to continue to use the healthcare system differently from the previously insured. This question may be important to consider as health coverage expansions are implemented.

}, keywords = {Aged, Female, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Male, Medically Uninsured, Medicare, Middle Aged, Socioeconomic factors, United States}, issn = {1099-1050}, doi = {10.1002/hec.1780}, author = {Decker, Sandra L and Jalpa A Doshi and Amy E. Knaup and Daniel Polsky} } @article {7678, title = {The influence of changes in dental care coverage on dental care utilization among retirees and near-retirees in the United States, 2004-2006.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, note = {Times Cited: 0 Manski, Richard J. Moeller, John F. St Clair, Patricia A. Schimmel, Jody Chen, Haiyan Pepper, John V.}, month = {2011 Oct}, pages = {1882-91}, publisher = {101}, abstract = {

OBJECTIVES: We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status.

METHODS: We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates.

RESULTS: We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods.

CONCLUSIONS: Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health.

}, keywords = {Age Factors, Aged, Dental Care, Employment, Female, Health Care Surveys, Humans, Insurance, Dental, Male, Medically Uninsured, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2011.300227}, author = {Richard J. Manski and John F Moeller and Patricia A St Clair and Jody Schimmel and Haiyan Chen and John V Pepper} } @article {7404, title = {Changes in functional status among persons over age sixty-five undergoing total knee arthroplasty.}, journal = {Med Care}, volume = {47}, year = {2009}, month = {2009 Jul}, pages = {742-8}, publisher = {47}, abstract = {

BACKGROUND: This study assessed changes in physical functional status following receipt of total knee arthroplasty (TKA) for patients diagnosed with osteoarthritis (OA) of the knee in a national sample of persons aged 65+ in the United States relative to a sample of similar OA patients who did not receive TKA.

METHODS: Data from the Health Retirement Survey (HRS) and linked Medicare claims from 1994 to 2006 were used to identify persons with diagnoses of OA of the lower leg who received a TKA (n = 516) and those who did not receive TKA (n = 1756). Predicted probabilities of receiving total knee arthroplasty from logit analysis were used for matching TKA and comparison groups on demographic, socioeconomic, and baseline functional status factors. Functional status measures were: mobility, gross motor function, large muscle, and limitations in activities of daily living (ADL). Average treatment effects of the treated (ATT), which compares changes in functional status between those who received TKA with similar individuals who did not receive TKA, were computed using propensity score matching.

RESULTS: Mobility (average treatment effect of the treated (ATT = 0.315; 95\% CI: 0.118-0.512), gross motor function (ATT = 0.314; 95\% CI: 0.156-0.472), and ADL limitations (ATT = 0.174; 95\% CI: 0.055-0.293), improved among persons receiving TKA relative to the comparison group. Relative to the mean values of the physical function at baseline, mobility, gross motor function, and ADL limitations persons receiving TKA had better functional outcomes than the comparison group by 17.5, 39.3, and 46.9 percent, respectively.

CONCLUSIONS: TKA is effective in improving functional status in elderly persons.

}, keywords = {Activities of Daily Living, Aged, Arthroplasty, Replacement, Knee, Attitude to Health, Geriatric Assessment, Health Care Surveys, Health Status, Health Surveys, Humans, Insurance Claim Reporting, Logistic Models, Longitudinal Studies, Medicare, Mobility Limitation, Multivariate Analysis, Muscle Weakness, Osteoarthritis, Knee, pain, Sensitivity and Specificity, Surveys and Questionnaires, Treatment Outcome, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e31819a5ae3}, author = {Frank A Sloan and Ruiz, David and Alyssa C Platt} } @article {7407, title = {Effect of Medicare home health care payment on informal care.}, journal = {Inquiry}, volume = {46}, year = {2009}, month = {2009 Spring}, pages = {58-71}, publisher = {46}, abstract = {

This paper assesses the effect of payment caps for Medicare home health care on the use of informal care by older adults with functional limitations. We find that individuals exposed to more restrictive payment caps offset reductions in Medicare home health care with increased informal care, although we only observe this effect for lower-income individuals. This suggests that home care payment restrictions may have increased the caregiving burden on some low-income families, but that many higher-income families were able to either forgo the care or finance it privately. Home care payment policies should recognize these effects, balancing costs of the program with the desire to protect families from the burdens associated with providing informal home care.

}, keywords = {Caregivers, Confidence Intervals, Female, Health Care Surveys, Home Care Services, Humans, Male, Medicare, Organizational Policy, Reimbursement Mechanisms, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_46.01.58}, author = {Ezra Golberstein and David C Grabowski and Kenneth M. Langa and M.E. Chernew} } @article {7204, title = {Spousal concordance in health behavior change.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Feb}, pages = {96-116}, publisher = {43}, abstract = {

OBJECTIVE: This study examines the degree to which a married individual{\textquoteright}s health habits and use of preventive medical care are influenced by his or her spouse{\textquoteright}s behaviors.

STUDY DESIGN: Using longitudinal data on individuals and their spouses, we examine changes over time in the health habits of each person as a function of changes in his or her spouse{\textquoteright}s health habits. Specifically, we analyze changes in smoking, drinking, exercising, cholesterol screening, and obtaining a flu shot.

DATA SOURCE: This study uses data from the Health and Retirement Study (HRS), a nationally representative sample of individuals born between 1931 and 1941 and their spouses. Beginning in 1992, 12,652 persons (age-eligible individuals as well as their spouses) from 7,702 households were surveyed about many aspects of their life, including health behaviors, use of preventive services, and disease diagnosis.

SAMPLE: The analytic sample includes 6,072 individuals who are married at the time of the initial HRS survey and who remain married and in the sample at the time of the 1996 and 2000 waves.

PRINCIPAL FINDINGS: We consistently find that when one spouse improves his or her behavior, the other spouse is likely to do so as well. This is found across all the behaviors analyzed, and persists despite controlling for many other factors.

CONCLUSIONS: Simultaneous changes occur in a number of health behaviors. This conclusion has prescriptive implications for developing interventions, treatments, and policies to improve health habits and for evaluating the impact of such measures.

}, keywords = {Attitude to Health, Cross-Sectional Studies, Exercise, Family Characteristics, Female, Health Behavior, Health Care Surveys, Health Promotion, Health Status, Humans, Interpersonal Relations, Life Style, Male, Marriage, Middle Aged, Preventive Health Services, Prospective Studies, Risk-Taking, Smoking, Spouses, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00754.x}, author = {Tracy Falba and Jody L Sindelar} } @article {6976, title = {Informal care and health care use of older adults.}, journal = {J Health Econ}, volume = {23}, year = {2004}, month = {2004 Nov}, pages = {1159-80}, publisher = {23}, abstract = {

Informal care by adult children is a common form of long-term care for older adults and can reduce medical expenditures if it substitutes for formal care. We address how informal care by all children affects formal care, which is critically important given demographic trends and the many policies proposed to promote informal care. We examine the 1998 Health and Retirement Survey (HRS) and 1995 Asset and Health Dynamics Among the Oldest-Old Panel Survey (AHEAD) using two-part utilization models. Instrumental variables (IV) estimation controls for the simultaneity of informal and formal care. Informal care reduces home health care use and delays nursing home entry.

}, keywords = {Aged, Female, Health Care Surveys, health policy, Health Services for the Aged, Home Care Services, Home Nursing, Homes for the Aged, Humans, Male, Nursing homes, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2004.04.008}, author = {Courtney Harold Van Houtven and Edward C Norton} } @article {6922, title = {Quality of preventive clinical services among caregivers in the health and retirement study.}, journal = {J Gen Intern Med}, volume = {19}, year = {2004}, month = {2004 Aug}, pages = {875-8}, publisher = {19}, abstract = {

We examined the association between caregiving for a spouse and preventive clinical services (self-reported influenza vaccination, cholesterol screening, mammography, Pap smear, and prostate cancer screening over 2 years and monthly self-breast exam) for the caregiver in a cross-sectional analysis of the Health and Retirement Study, a nationally representative sample of U.S. adults aged > or = 50 years (N = 11,394). Spouses engaged in 0, 1-14, or > or = 14 hours per week of caregiving. Each service was examined in logistic regression models adjusting for caregiver characteristics. After adjustment for covariates, there were no significant associations between spousal caregiving and likelihood of caregiver receipt of preventive services.

}, keywords = {Aged, Caregivers, Cohort Studies, Cross-Sectional Studies, Female, Health Care Surveys, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Preventive Health Services, Quality of Health Care, Time Factors, United States}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2004.30411.x}, author = {Kim, Catherine and Mohammed U Kabeto and Robert B Wallace and Kenneth M. Langa} } @article {6860, title = {High out-of-pocket health care spending by the elderly.}, journal = {Health Aff (Millwood)}, volume = {22}, year = {2003}, month = {2003 May-Jun}, pages = {194-202}, publisher = {22}, abstract = {

We use data from the Health and Retirement Study to examine the elderly{\textquoteright}s out-of-pocket health care spending. We find that Medicare HMOs, employer supplements, and Medicaid effectively insulate against the risk of high expenditures. At the ninetieth percentile, Medicare beneficiaries with employer supplements or enrolled in Medicare HMOs spend 1,600 dollars less out of pocket than beneficiaries with traditional Medicare spend. For the poor elderly, Medicaid offers similar protection. Among the near-poor elderly, there is little employer coverage, so Medicare HMOs provide most of the protection against financial risk. There is evidence that Medicare HMO benefits have eroded since 1998, raising the question of whether the near-poor have lost financial protection since then.

}, keywords = {Aged, Drug Costs, Drug Prescriptions, Financing, Personal, Health Care Surveys, Health Expenditures, Health Maintenance Organizations, Health Services for the Aged, Humans, Insurance, Health, Medicare, Poverty, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.22.3.194}, author = {Dana P Goldman and Julie M Zissimopoulos} } @article {6792, title = {State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis.}, journal = {J Health Soc Behav}, volume = {43}, year = {2002}, note = {RDA 1996-025}, month = {2002 Mar}, pages = {107-24}, publisher = {43}, abstract = {

Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults{\textquoteright} strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals{\textquoteright} demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Female, Financing, Government, Frail Elderly, Health Care Surveys, Health Expenditures, Home Care Services, Humans, Logistic Models, Male, State Government}, issn = {0022-1465}, doi = {10.2307/3090248}, author = {Muramatsu, Naoko and Richard T. Campbell} } @article {6726, title = {The explosion in paid home health care in the 1990s: who received the additional services?}, journal = {Med Care}, volume = {39}, year = {2001}, month = {2001 Feb}, pages = {147-57}, publisher = {39}, abstract = {

OBJECTIVE: Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services.

METHODS: The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members.

RESULTS: Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05).

CONCLUSIONS: The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Family Characteristics, Female, Financing, Government, Frail Elderly, Geriatric Assessment, Health Care Surveys, Health Expenditures, health policy, Home Care Services, Home Nursing, Humans, Longitudinal Studies, Male, Marital Status, Multivariate Analysis, Social Support, Socioeconomic factors, Surveys and Questionnaires, United States, Utilization Review}, issn = {0025-7079}, doi = {10.1097/00005650-200102000-00005}, author = {Kenneth M. Langa and M.E. Chernew and Mohammed U Kabeto and Steven J. Katz} } @article {6723, title = {Expectations among the elderly about nursing home entry.}, journal = {Health Serv Res}, volume = {35}, year = {2000}, month = {2000 Dec}, pages = {1181-202}, publisher = {35}, abstract = {

OBJECTIVE: To assess whether the covariates that explain expectations of nursing home entry are consistent with the characteristics of those who enter nursing homes.

DATA SOURCES: Waves 1 and 2 of the Assets and Health Dynamics Among the Oldest Old (AHEAD) survey.

STUDY DESIGN: We model expectations about nursing home entry as a function of expectations about leaving a bequest, living at least ten years, health condition, and other observed characteristics. We use an instrumental variables and generalized least squares (IV-GLS) method based on Hausman and Taylor (1981) to obtain more efficient estimates than fixed effects, without the restrictive assumptions of random effects.

PRINCIPAL FINDINGS: Expectations about nursing home entry are reasonably close to the actual probability of nursing home entry. Most of the variables that affect actual entry also have significant effects on expectations about entry. Medicaid subsidies for nursing home care may have little effect on expectations about nursing home entry; individuals in the lowest asset quartile, who are most likely to receive these subsidies, report probabilities not significantly different from those in other quartiles. Application of the IV-GLS approach is supported by a series of specification tests.

CONCLUSIONS: We find that expectations about future nursing home entry are consistent with the characteristics of actual entrants. Underestimation of risk of nursing home entry as a reason for low levels of long-term care insurance is not supported by this analysis.

}, keywords = {Activities of Daily Living, Aged, Attitude to Health, Data Interpretation, Statistical, Effect Modifier, Epidemiologic, Female, Geriatric Assessment, Health Care Surveys, Health Services Research, Health Status, Homes for the Aged, Humans, Least-Squares Analysis, Longevity, Male, Medicaid, Nursing homes, Patient Admission, Probability, Risk Factors, Surveys and Questionnaires, United States}, issn = {0017-9124}, author = {Richard C Lindrooth and Hoerger, Thomas J. and Edward C Norton} } @article {6698, title = {Uninsured status and out-of-pocket costs at midlife.}, journal = {Health Serv Res}, volume = {35}, year = {2000}, month = {2000 Dec}, pages = {911-32}, publisher = {35}, abstract = {

OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period.

DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline.

STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage.

PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance.

CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.

}, keywords = {Age Factors, Female, Financing, Personal, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Models, Econometric, Multivariate Analysis, Surveys and Questionnaires, United States}, issn = {0017-9124}, author = {Richard W. Johnson and Crystal, Stephen} } @article {6575, title = {Health insurance coverage at midlife: characteristics, costs, and dynamics.}, journal = {Health Care Financ Rev}, volume = {18}, year = {1997}, month = {1997 Spring}, pages = {123-48}, publisher = {18}, type = {Journal}, abstract = {

Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.

}, keywords = {Age Factors, Costs and Cost Analysis, Demography, Female, Health Benefit Plans, Employee, Health Care Surveys, Humans, Insurance Coverage, Insurance, Health, Logistic Models, Longitudinal Studies, Male, Middle Aged, United States}, issn = {0195-8631}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194511/}, author = {Richard W. Johnson and Crystal, Stephen} } @article {6588, title = {Medical insurance and the use of health care services by the elderly.}, journal = {J Health Econ}, volume = {16}, year = {1997}, month = {1997 Apr}, pages = {129-54}, publisher = {16}, abstract = {

The objective of this paper is to find how health insurance influences the use of health care services by the elderly. On the basis of the first wave of the Asset and Health Dynamics Survey, we find that those who are the most heavily insured use the most health care services. Because our data show little relationship between observable health measures and either the propensity to hold or to purchase private insurance, we interpret this as an effect of the incentives embodied in the insurance, rather than as the result of adverse selection in the purchase of insurance.

}, keywords = {Activities of Daily Living, Aged, Health Care Surveys, Health Services for the Aged, Health Status Indicators, Hospitalization, Humans, Insurance, Health, Medicare, Office Visits, Patient Acceptance of Health Care, Private Sector, Probability, United States}, issn = {0167-6296}, doi = {10.1016/s0167-6296(96)00515-2}, url = {https://www.ncbi.nlm.nih.gov/pubmed/10169091}, author = {Michael D Hurd and Kathleen McGarry} }