Effects of state medicaid policies on the likelihood of nursing home admission and length of stay: An application of the competing-risks model.
Item
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Title
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Effects of state medicaid policies on the likelihood of nursing home admission and length of stay: An application of the competing-risks model.
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Identifier
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AAI9720123
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identifier
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9720123
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Creator
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Noguchi, Haruko.
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Contributor
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Adviser: Linda N. Edwards
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Date
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1997
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Language
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English
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Publisher
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City University of New York.
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Subject
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Economics, General | Health Sciences, Nursing | Gerontology
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Abstract
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The main purpose of this thesis is to investigate the influences of both an elderly person's health stock and the variation in Medicaid policies among states on an elderly person's risks of nursing home entry and discharge and the hazard of mortality (either in the community or in a nursing home), using the National Long-Term Care Survey (NLTCS). At first, I analyze these risk in a competing risks approach in two periods, 1982-1984 and 1984-1989, separately. Secondly, I extend the regression form of a semi-parametric hazard model to the model with time-varying covariates, which allows the effect of independent variables that vary over time.;I find that an individual's health stock at the start of each survey period, 1982-1984 and 1984-1989, has a significant positive effect on the probability of nursing home entry during the survey period. I also find evidence suggesting that some public support to an elderly person could materially affect his or her input price for long-term care. The presence of a "medically needy" program increases an elderly person's probability of institutionalization by approximately 30 percent during both study periods. In contrast, Medicaid coverage for home and community-based care decreases the hazard (probability) of nursing home entry by 19.9 percent in the study period 1982-1984. However, as to Medicaid coverage for home care, I cannot obtain a significant result from the regression during the second survey period. Weekly average wage in Intermediate Care Facilities in the state as a proxy of the price of nursing home care affects an elderly person's use of nursing home care in both study periods.;If one controls for time-varying covariates, both effects of a Medicaid dummy variable and a proxy variable for the price of nursing home care on the risk of mortality in the community becomes significantly negative. The reason for this is that these covariates (an increase in the depreciation rate of an elderly person's health stock, losing a source of informal caregiving, and a decrease in economic resources among the elderly over time) are all conducive to an elderly person's hazard of death in the community.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
