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

  1. Given the relatively low incidence of LTC insurance ownership in the general population age 65 and over -- less than 5% -- and given the characteristics of these individuals, all are assumed not to have LTC insurance.

  2. The participating companies included: (1) Aegon; (2) American Travellers; (3) Bankers Life and Casualty; (4) CNA Insurance; (5) Fortis Long-Term Care; (6) G.E. Capital Assurance; (7) John Hancock; and (8) UNUM. Together the claimant blocks from these companies represent more than 80% of all open home health care claims and nursing home claims. These companies also represent diverse market segments and policy designs, and employ differing underwriting and claims management strategies.

  3. Policymakers not in claim were surveyed to find out how many policyholders who met the qualifying criteria to trigger benefits had not yet filed a claim or had perhaps had claims inappropriately denied.

  4. The ADL activities include bathing, dressing, toileting, transferring, continence management, and feeding. A disability is present if an individual requires stand-by, cueing, or hands-on assistance.

  5. Having 4 or more errors on the SPMSQ.

  6. The reason why a sub-sample of claimants is used is because 15% of them did not meet the minimum disability threshold. Therefore, they were excluded from subsequent analyses. For more information about these individuals see "A Descriptive Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community", Department of Health and Human Services and Robert Wood Johnson Foundation, April, 1999.

  7. The mean number of ADL and IADL hours received by individuals in this sample is 54 hours per week.

  8. To test this finding further, the second equation was estimated without the adjustment for sample selection (IMR). For the most part, coefficients on included variables did not change, which means that the unobserved variables associated with having an insurance policy do not influence the amount of care among individuals in the Insured Panel.

  9. Given the significant time and expense that goes into the underwriting process of LTC insurers, it is not entirely surprising that these insured individuals were not found to have a propensity to consume services more than non-insured individuals. When individuals apply for insurance, the insurance carriers successfully screen out those who they can identify as being above average risks for needing care.

  10. It is important to note that the "average" effect is estimated when all other variables in the equation are evaluated at their mean values.

  11. The diagnoses tested include diabetes, cancer, paralysis, pneumonia, stroke, heart disease, fractures and a category capturing other diagnoses.

  12. Note that the negative effect of the "income-LTC Insurance" interaction term must be accounted for when comparing the impact of insurance among the privately insured with the impact of insurance among the publicly insured. The negative coefficient on the interaction term suggests that having private insurance provides about 10 rather than 11 additional weekly hours of care.

  13. The findings related to Medicaid should be viewed with caution. Only 4% of the sample received Medicaid financed home care services. For the most part, such programs are not considered overly generous in terms of benefits. Thus, the findings that individuals with Medicaid do receive more total care than do those without such insurance, while significant, may also be an artifact of the relatively small sample.

  14. For more detailed information on the use of Medicare home health services see Jackson, B. and Doty, P. (1999). Medicare Home Health Services 1989-1994: Patterns of Benefit Use Among Chronically Disabled Elders. Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy, U.S. Department of Health and Human Services, Washington, D.C.

  15. This is just the reciprocal of .17, and reflects the odds of Medicare use among the non-insured compared to the insured.

  16. The average daily benefit is inflated by 3% per year. Thus, in 1999 dollars, the per-visit costs are $74.97. Savings are derived by multiplying current Medicare home health use (5.6% of claimants) times the expected Medicare costs and subtracting this from the projected costs in the absence of the private insurance (11% of claimants) times the expected Medicare Costs. This is given as [(100)*(.11)*($74.97)*(51)]-[(100)*(.056)*($74.97)*(51)] = $20,647.

  17. For more information see Cohen, M. and Tumlinson, A. (1995). "Understanding State Variation in Medicare Home Health Care: The Impact of Medicaid Program Characteristics, State Policy and Provider Behavior." Medical Care, Volume 35, Number 6.

  18. It is important to note that "self-reported" undermet ADL needs for the cognitively impaired is actually provided by primary informal caregivers.

  19. We tested insurance policy design variables among the privately insured sample and found that the only significant variable was "policy type"; individuals who had a pure disability policy design were less likely to report undermet ADL needs than were those with indemnity or reimbursement policies.

  20. The dependent variable was recoded to be dichotomous: satisfied and dissatisfied.

  21. The Kaye-Meyer-Olkin (KMO) measure of sampling adequacy is 69.2%. This indicates that factor analysis is a reasonable method of analysis as correlations between pairs of variables can be explained by other variables; this is an important prerequisite for conducting factor analysis.

  22. It is important to note that there must be at least one variable in the first equation that is not included in the second equation, otherwise, the Inverse Mills Ratio would be a linear combination of other variables in the model.

To obtain a printed copy of this report, send the full report title and your mailing information to:

U.S. Department of Health and Human Services
Office of Disability, Aging and Long-Term Care Policy
Room 424E, H.H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
FAX:  202-401-7733

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