The Aging Population in the Twenty-First Century Statistics for Health Policy (1988) / Chapter Skim
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8 The Financing of Health Care Services for the Elderly
8 The Financing of Health Care Services for the Elderly
Pages 150-177
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From page 150... ...
As a consequence, health care financing has become one of the more critical policy issues to be addressed by the nation. The methods used to finance health care services have important effects on the use of health care services by the elderly and their level of health and well being, as well as on the growth and development of the health care sector itself.
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From page 151... ...
What alternative financing mechanisms for the supply of longterm care services should be supported and by whom? What changes in funding mechanisms, legislation, and public policy are necessary to shift the emphasis away from hospital and nursing home care toward less costly alternatives?
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From page 152... ...
Medicare consists of two separate but complementary programs: Hospital Insurance (HI) for services furnished in hospitals, in skilled nursing facilities, and by home health agencies; and Supplementary Medical Insurance (SMI)
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From page 153... ...
The extent to which the program actually pays for services such as skilled nursing facilities and home health, usually considered long-term care services is therefore very limited. People are automatically enrolled in HI within a short time of reaching their sixty-fifth birthday.
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From page 154... ...
As with Medicare, there is a concerted effort to reevaluate the structure of the program, in particular with respect to long-term services, to revise the methods used to reimburse providers, especially nursing homes, and to change the income eligibility levels.
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From page 155... ...
Since most veterans are covered by Medicare, the service that is likely to be most attractive to the older veteran is nursing home care. However, the main factor that will influence the veteran's use of nursing home services is the number of nursing home beds available within the VA system.
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From page 156... ...
In general, most of these policies fill the gaps in Medicare-covered services, such as the coinsurance and deductible provisions, rather than extending insurance protection against uncovered services such as long-term care services or outpatient drugs (Rice and McCall, 1985~. With the projected large increase in the number' of people age 65 and over, especially those age 85 and over, there is increased interest in finding mechanisms for stimulating the development of private insurance coverage for long-term care services (Meiners, 1985a)
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From page 157... ...
For example, consider the 1980 National Medical Care Utilization and Expenditure Survey expenditures data for three groups of the noninstitutionalized elderly: the "low-cost" users, those with expenditures less than $500, "medium-cost" users, with expenditures between $500 and $3,000, and the "high-cost" users, those with expenditures over $3,00~0. Although these categories are somewhat arbitrary, they help to establish the well-known fact that health care expenditures are concentrated on a small number of sick people.
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From page 158... ...
People in nursing homes, who incur large out-of-pocket expenditures- because both the cost of the service is so high and insurance is so limited are not included in the National Medical Care Utilization and Expenditure Survey, the source of the above data.
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From page 159... ...
The current extensive use of unpaid health care makes it very difficult to design a public financing program for health care services that will encourage the efficient substitution of home-based services for nursing home services, because any such program is also likely to lead to a substitution of services provided by the family or already paid for by the individuals or their families for publicly funded home care services. Thus in evaluating proposals to change the financing of long-term care services for the elderly, data are needed to assess the extent that financing mechanisms will lead to an increase in the use of services or to a substitution of publicly funded services for services previously provided by the family free of charge or paid by the individuals and their families If new services are used, to what extent will they act as complements or as substitutes for nursing home care?
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From page 160... ...
Timely Data on Expenditures for the El(lerly The Health Care Financing Administration periodically pub fishes data on health care expenditures of the population age 65 and
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From page 161... ...
. National Medical Expenditure Survey The 1987 National Medical Expenditure Survey follows a series of national medical expenditures surveys, including the 1980 National Medical Care Utilization and Expenditures Survey and the 1977 National Medical Care Expenditures Survey.
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From page 162... ...
An important feature of the NMES is an Institutional Population Component (IPC) , which will survey about 10,000 persons in nursing homes, facilities for the mentally retarded, and psychiatric hospitals and collect data similar to those for the noninstitutionaTized household population.
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From page 163... ...
The National Medical Expenditure Survey will provide a rich source of data on the health services utilization and expenditure patterns of the community-residing and institutionalized elderly. Its panel design may permit assessment of the impact of changes in service delivery and payment systems experienced by some of its respondents during the course of a calendar year on their utilization of health services and expenditures for health care.
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From page 164... ...
Recommendation 8.4: The pane! recommends that the National Center for Health Services Research and Health Care Technology identify and follow the population age 55 and over in the 1987 National Medical Expenditure Survey through the linking of administrative records, including Medicare reimbursements from Health Care Financing Administration records, and, to the extent feasible, Medicaid reimbursements from state record systems.
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From page 165... ...
begin planning an outreach program, including the conduct of conferences for data tape users similar to those conducted by federal agencies such as the National Center for Health Statistics and the Census Bureau, to inform and educate the policy and research communities in the efficient use of the forthcoming 1987 NMES data tapes and (b) prepare a schedule for the timely release of the National Medical Expenditure Survey data tapes, prepare these public use data tapes as soon as feasible after the reference period, and make them available to the policy and research communities outside the National Center for Health Services Research.
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From page 166... ...
Recommendation 8.6: The panel recommends that the Health Care Financing Administration devote more resources, including budget and staff, to the timely release, publication, and analysis of data from the Medicare Statistical System, including national and geographic data on enrollees, providers, and reimbursements. Unproved Access to Medicare Data The volume of data potentially available from the MSS is large and especially useful for evaluating different aspects of the Medicare programs as noted above.
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From page 167... ...
Recommendation 8.7: The pane! recommends that the Health Care Financing Administration develop files designed for easy access to the Medicare Statistical System, including the Medicare Automated Data Retrieval System, that would facilitate use by researchers for policy analysis related to the Medicare program.
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From page 168... ...
Recommendation 8.9: The pane] recommends that the Health Care Financing Administration develop a data system for information on Medicare beneficiaries in capitated systems that is beneficiary-based, able to accommodate different types of capitated plans, reflect differences in services offered and in cost sharing, and utilizes uniform and consistent data definitions and formats among different types of plans.
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From page 169... ...
recommends that studies of the Continuous Disability History Sample linked to Medicare files be fully supported jointly by the Health Care Financing Administration and the Social Security Administration and that a public use tape be prepared for this linked file with identifiers deleted as necessary to comply with confidentiality requirements.
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From page 170... ...
The HCFA hospital bill includes items for patients discharged to home under care of organized home health services, discharged to skilled nursing home or to intermediate nursing facility, in addition to the items on the Uniform Hospital Discharge Data Set (UHDDS) : routine discharge, left against medical advice, discharged to another short-term hospital, discharged to a long-term care institution, died, and not stated.
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From page 171... ...
The tapes include four different person identifiers on each enrollee, making it possible to link the data with other data sets and national surveys. Experimental studies conducted inside and outside the Health Care Financing Administration-some of which have involved elderly utilization patterns have yielded high match rates.
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From page 172... ...
Recommendation 8.12: The pane! recommends that the Medicaid Tape-to-Tape Project be continued, and that the Health Care Financing Administration continue to conduct studies on utilization patterns and expenditures of the elderly using this data base and create sample files and public use tapes for use by outside researchers.
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From page 173... ...
Although many elderly people think nursing home services are covered by Medicare, they are not. The Medicaid program is the principal source of public financing for nursing home care, paying for services provided to the indigent and the "medically needy" those whose income and assets fall below a legally defined level.
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From page 174... ...
Information on persons involved in the spend-down can be compiled for the 5 percent of Medicaid beneficiaries who are in nursing homes and are selected in the Quality Control sample of 400,000 persons nationwide. Information about the effect of spend-down on the family may be obtained from two ongoing surveys.
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From page 175... ...
In addition to data on prevalence, incidence, and use of medical care and long-term care services for the elderly suffering from these and other conditions, the costs of these conditions are needed by policy makers, health planners, and researchers to set priorities, make program policy decisions, and prepare and deliver congressional testimony to support program policy decisions and agency budgets. The economic costs of illness represent the monetary burden on society of illness and premature death.
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From page 176... ...
, few studies follow them rigorously. For the further development of cost-of-illness studies, data will be available from several surveys including the 1987 National Medical Care Expenditure Survey, the 1985 National Nursing Home Survey, the annual National Hospital Discharge Survey, and the annual National Health Interview Survey.
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From page 177... ...
-~c ~ ~~ ^~E ~ Rec_udatlon 8.13: Tbe panel recommends that the National Center for Herb Servlces Hesearcb, the Oblong Center far Heabb Stat~tlcs, Id the HeaRb Care Flnanclng Ad~lnlstratlon continue to collect the detailed data necessary to estimate the economic costs of illnesses, especl~Ry those ^ctlog the elderly populatlon, and that the Nylons Center ~r Healtb Servlces Hesearcb support cost-oLlDness studles uslng =~le guldeUnes ~r uD~rm metbodology.
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