RAND Roybal Center for Health Policy Simulation

Protecting the vulnerable elderly

Nursing Home Workforce Dynamics and Quality of Care (John Engberg)

This application pilot will estimate and simulate a model of the impact of workforce dynamics on nursing home quality of care. This project will use a combination of secondary data from national surveys of nursing home characteristics and quality of care and primary data from a unique survey that captures many dimensions of workforce dynamics. The project goal is to understand the effect of nursing home human resource decisions and state workforce programs and policies on caregiver workforce dynamics, controlling for underlying supply and demand factors, and, in turn, the effect of workforce dynamics on the quality of nursing home care.

Eligibility for Comprehensive End of Life Services: Developing and Piloting a Method (Anne Wilkinson)

The onset of complex and progressive chronic illness probably should mark a shift in the organization and delivery of care and in the coverage options for that care, since people living with worsening disability and symptoms prioritize continuity, comfort, caregiver support, choice, and reliability. No available markers of onset of this condition meet requirements for administrative or clinical use. This pilot aims to develop criteria for the onset of complex and progressive chronic illness from data in Medicare claims and in the Current Medicare Beneficiary Survey and to examine the attributes of the population that these markers define. The proposed work will develop and pilot-test methods for two illustrative conditions, lung cancer and emphysema, using case review, application of algorithms to the Medicare population, and descriptive characterization of the course and resource use of those with advanced illness.

Adverse Selection, Population Aging, and the Market for Supplementary Health Insurance (Nicole Maestas)

The market for supplementary health insurance for the elderly, known as the "Medigap" market, has long thought to be vulnerable to adverse selection. However, most empirical studies have found only modest evidence of selection. This research pilot examines the risk structure of the market, and shows how population aging has the potential to destabilize the market, causing spiraling premiums and possibly even the disappearance of the market.

Tools for Efficient Allocation of Fall-Prevention Resources (Shinyi Wu)

This application pilot will translate evidence-based findings into a decision-support tool for best allocating resources to prevent falls.It will summarize a comprehensive list of falls-prevention interventions that evidence reports have concluded to be effective, and will estimate their costs and benefits at the population-policy level. The tool will take into account the preferences of policymakers and scalability of an intervention when making recommendations. Our long-term objectives are to expand this tool to include other health interventions-such as health promotion and disease prevention-to encourage better health investment decisions.

Who Will be Available to Support the Elderly? Welfare-State Policy, Fertility, and Population Age Structure (Allen Jui-Chung Li)

The ultimate goals of the proposed research are to improve the prediction of future age structures through improved projection of fertility, and to provide information on how welfare-state policies may influence population aging through changes in family and childbearing behaviors.

Health Impacts of Retirement (Gema Zamarro)

What are the health impacts of retirement? As talk of raising retirement ages in pensions and social security schemes continues around the world, it is important to know both the costs and benefits for the individual as well as the governments' budgets. In this study, we propose to use large scale survey data on elderly populations in Europe to examine the following specific questions in a multi-country setting:

  1. What is the effect of retirement on measures of general health?
  2. What is the effect of retirement on measures of mental health?