Multivariate Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community. BACKGROUND


In April of 1999, a report entitled "A Descriptive Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community" was submitted to the Department of Health and Human Services and the Robert Wood Johnson Foundation. The purpose of that report was to provide basic descriptive statistics on disabled policyholders of private long-term care (LTC) insurance who had accessed long-term care benefits in the community. Information about these individuals and their service use was then compared to similar data among non-insured disabled community-dwelling elders.

In that report, we provided detailed descriptive information on the socio-demographic and service utilization profile of disabled claimants receiving home and community-based care benefits under their LTC insurance policies. We also characterized the level and mix of informal and formal support received by disabled claimants, and this was compared to a nationally representative sample of non-privately insured disabled elders living in the community. Identified were the factors associated with observed differences between the two groups in relation to the utilization of home care, and measured was caregiver effort on each group's behalf. Finally, we evaluated claimant and caregiver perceptions regarding the value of their LTC policy and estimated the extent of unmet and undermet need. The findings of the descriptive analyses served as a basis for highlighting important policy implications related to the service delivery system and to the design of private and public LTC policies and programs.

Because claimants with private LTC insurance had never been studied, let alone compared to disabled individuals without insurance, the basic descriptive information generated from the study has made an important contribution to the knowledge base. Moreover, many of the comparative descriptive analyses showed important differences between the privately insured and non-privately insured groups along a number of important dimensions. For example, we showed that individuals with private insurance use less informal care but on average use more total weekly assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) than do those without insurance. We also showed that the use of Medicare funded home health services is much lower among the privately insured than among those without private insurance. Finally, a significant minority of individuals with private LTC insurance reported undermet ADL needs.

While these findings are important, it is difficult to know what explains these observed differences. That is, we cannot know whether greater use of care among the privately insured is due to factors unrelated to the presence of insurance benefits. Perhaps the privately insured are more disabled, are more likely to be married, have greater wealth, or differ in other ways that result in their having a higher propensity to consume services. Until these other variables are controlled for, it is difficult to know the extent to which having insurance itself influences service use. For those interested in studying, regulating, or helping to develop and encourage growth in the private insurance market, having such information is particularly important.

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