A comparative analysis of Medicaid long‐term care policies and their effects on elderly dual enrollees
研究使用简化计量模型和调查数据，分析美国各州医疗补助长期护理政策组合对老年双重参保者护理获取、日常活动帮助和未满足需求的影响，发现高社区支出与低人均社区支出组合最有效。
Individuals with dual enrollment in Medicare and Medicaid have become the focus of heightened US federal and state policy interest in recent years. These beneficiaries are among the most vulnerable and costly persons served by either program. This analysis uses a reduced-form econometric model and a unique survey of community-resident dual enrollees to take a critical step toward understanding the relationships and combinations of state long-term care (LTC) policies and their relative effectiveness in achieving their intended effects: increasing access to care, improving activities of daily living/instrumental activities of daily living (ADL/IADL) assistance, and reducing unmet needs. We then simulate the effects of alternative policies to determine the most effective combination.The combination of policies that was most effective in reducing the percentage of individuals receiving low levels of assistance was high spending in the community relative to nursing home and low community LTC spending per recipient; that is, spending more on community care and spreading it across more people. Overall, this analysis confirms that Medicaid LTC policy decisions by states, and the combinations of policies that are implemented, result in important variations in levels of assistance to elderly persons with disabilities.