{"id":"https://openalex.org/W2181190710","doi":"https://doi.org/10.1377/hlthaff.2015.1226","title":"Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending","display_name":"Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending","publication_year":2015,"publication_date":"2015-11-16","ids":{"openalex":"https://openalex.org/W2181190710","doi":"https://doi.org/10.1377/hlthaff.2015.1226","mag":"2181190710","pmid":"https://pubmed.ncbi.nlm.nih.gov/26572919"},"language":"en","primary_location":{"id":"doi:10.1377/hlthaff.2015.1226","doi":"https://doi.org/10.1377/hlthaff.2015.1226","is_oa":false,"landing_page_url":"https://doi.org/10.1377/hlthaff.2015.1226","pdf_url":null,"source":{"id":"https://openalex.org/S4210185023","display_name":"Health Affairs","issn_l":"0278-2715","issn":["0278-2715","1544-5208","2694-233X"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":["anvur-scientific","dongbi-a","doyens","fnege-2","jufo-2","medline","norway-1","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315983","host_organization_name":"Project HOPE","host_organization_lineage":["https://openalex.org/P4310315983"],"host_organization_lineage_names":["Project HOPE"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Affairs","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5025753604","display_name":"Melissa M. Favreault","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I183320395","display_name":"Urban Institute","ror":"https://ror.org/017pz3h73","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I183320395"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Melissa M. Favreault","raw_affiliation_strings":["Melissa M. Favreault (         ) is a senior fellow in the Income and Benefits Policy Center at the Urban Institute, in Washington, D.C"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Melissa M. Favreault (         ) is a senior fellow in the Income and Benefits Policy Center at the Urban Institute, in Washington, D.C","institution_ids":["https://openalex.org/I183320395"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5052281458","display_name":"Howard Gleckman","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I183320395","display_name":"Urban Institute","ror":"https://ror.org/017pz3h73","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I183320395"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Howard Gleckman","raw_affiliation_strings":["Howard Gleckman is a senior fellow in the Urban-Brookings Tax Policy Center at the Urban Institute"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Howard Gleckman is a senior fellow in the Urban-Brookings Tax Policy Center at the Urban Institute","institution_ids":["https://openalex.org/I183320395"]}]},{"author_position":"last","author":{"id":null,"display_name":"Richard W. Johnson","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I183320395","display_name":"Urban Institute","ror":"https://ror.org/017pz3h73","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I183320395"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Richard W. Johnson","raw_affiliation_strings":["Richard W. Johnson is a senior fellow in the Income and Benefits Policy Center and director of the Program on Retirement Policy at the Urban Institute"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Richard W. Johnson is a senior fellow in the Income and Benefits Policy Center and director of the Program on Retirement Policy at the Urban Institute","institution_ids":["https://openalex.org/I183320395"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I183320395"],"apc_list":null,"apc_paid":null,"fwci":14.4775,"has_fulltext":false,"cited_by_count":53,"citation_normalized_percentile":{"value":0.98632908,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":91,"max":99},"biblio":{"volume":"34","issue":"12","first_page":"2181","last_page":"2191"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.9818999767303467,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.9818999767303467,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11376","display_name":"Geriatric Care and Nursing Homes","score":0.010900000110268593,"subfield":{"id":"https://openalex.org/subfields/2717","display_name":"Geriatrics and Gerontology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.001500000013038516,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/long-term-services-and-supports","display_name":"long-term services and supports","score":0.9539999961853027},{"id":"https://openalex.org/keywords/long-term-care-financing","display_name":"long-term care financing","score":0.8379999995231628},{"id":"https://openalex.org/keywords/long-term-care-insurance","display_name":"long-term care insurance","score":0.953000009059906},{"id":"https://openalex.org/keywords/medicaid","display_name":"Medicaid","score":0.6359999775886536},{"id":"https://openalex.org/keywords/older-adults","display_name":"older adults","score":0.6819999814033508},{"id":"https://openalex.org/keywords/disability","display_name":"disability","score":0.5090000033378601},{"id":"https://openalex.org/keywords/compulsory-insurance","display_name":"compulsory insurance","score":0.414000004529953},{"id":"https://openalex.org/keywords/voluntary-insurance","display_name":"voluntary insurance","score":0.8960000276565552},{"id":"https://openalex.org/keywords/insurance-subsidies","display_name":"insurance subsidies","score":0.49399998784065247},{"id":"https://openalex.org/keywords/out-of-pocket-costs","display_name":"out-of-pocket costs","score":0.7009999752044678},{"id":"https://openalex.org/keywords/federal-spending","display_name":"federal spending","score":0.7940000295639038},{"id":"https://openalex.org/keywords/policy-trade-offs","display_name":"policy trade-offs","score":0.5849999785423279}],"concepts":[{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.7546012997627258},{"id":"https://openalex.org/C84265765","wikidata":"https://www.wikidata.org/wiki/Q193219","display_name":"Subsidy","level":2,"score":0.7008894085884094},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.6889305114746094},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.5157554149627686},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.4818383455276489},{"id":"https://openalex.org/C102139631","wikidata":"https://www.wikidata.org/wiki/Q4406896","display_name":"Self-insurance","level":4,"score":0.429305762052536},{"id":"https://openalex.org/C3020096462","wikidata":"https://www.wikidata.org/wiki/Q43183","display_name":"Private insurance","level":4,"score":0.413726270198822},{"id":"https://openalex.org/C2780233487","wikidata":"https://www.wikidata.org/wiki/Q6672123","display_name":"Long-term care","level":2,"score":0.4107893109321594},{"id":"https://openalex.org/C100001284","wikidata":"https://www.wikidata.org/wiki/Q2248246","display_name":"Public economics","level":1,"score":0.3921506404876709},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.36117660999298096},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.29586827754974365},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.23311951756477356},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.1304364800453186},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.12738743424415588},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.0},{"id":"https://openalex.org/C34447519","wikidata":"https://www.wikidata.org/wiki/Q179522","display_name":"Market economy","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005380","descriptor_name":"Financing, Government","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007353","descriptor_name":"Insurance, Long-Term Care","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D008484","descriptor_name":"Medicaid","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011050","descriptor_name":"Policy Making","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D019458","descriptor_name":"Insurance Coverage","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true}],"locations_count":2,"locations":[{"id":"doi:10.1377/hlthaff.2015.1226","doi":"https://doi.org/10.1377/hlthaff.2015.1226","is_oa":false,"landing_page_url":"https://doi.org/10.1377/hlthaff.2015.1226","pdf_url":null,"source":{"id":"https://openalex.org/S4210185023","display_name":"Health Affairs","issn_l":"0278-2715","issn":["0278-2715","1544-5208","2694-233X"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":["anvur-scientific","dongbi-a","doyens","fnege-2","jufo-2","medline","norway-1","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315983","host_organization_name":"Project HOPE","host_organization_lineage":["https://openalex.org/P4310315983"],"host_organization_lineage_names":["Project HOPE"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Affairs","raw_type":"journal-article"},{"id":"pmid:26572919","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/26572919","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health affairs (Project Hope)","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.428600013256073,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":9,"referenced_works":["https://openalex.org/W1970717149","https://openalex.org/W1994546428","https://openalex.org/W2048008968","https://openalex.org/W2083844703","https://openalex.org/W2101351409","https://openalex.org/W2128768380","https://openalex.org/W2143163062","https://openalex.org/W2167386228","https://openalex.org/W3124393496"],"related_works":["https://openalex.org/W2556125028","https://openalex.org/W2798023391","https://openalex.org/W3044690611","https://openalex.org/W2623842189","https://openalex.org/W2263068127","https://openalex.org/W4237608837","https://openalex.org/W2788151600","https://openalex.org/W4238034667","https://openalex.org/W3113694413","https://openalex.org/W2125220741"],"abstract_inverted_index":{"About":[0],"half":[1,41],"of":[2,10,19,42,47,53,115,138,146],"older":[3],"Americans":[4],"will":[5,38,74],"need":[6],"a":[7,16,51,104,120,128],"high":[8,54],"level":[9],"assistance":[11],"with":[12,123],"routine":[13],"activities":[14],"for":[15,79],"prolonged":[17],"period":[18,114],"time.":[20],"This":[21],"help":[22],"is":[23,172,193],"commonly":[24],"referred":[25],"to":[26,69,77,173,194],"as":[27,50],"long-term":[28,63],"services":[29],"and":[30,56,127,135,141,143,200],"supports":[31],"(LTSS).":[32],"Under":[33],"current":[34],"policies,":[35],"these":[36,92],"individuals":[37],"fund":[39],"roughly":[40],"their":[43],"paid":[44],"care":[45,64],"out":[46],"pocket.":[48],"Partly":[49],"result":[52],"costs":[55],"uncertainty,":[57],"relatively":[58,110],"few":[59],"people":[60],"purchase":[61],"private":[62],"insurance":[65,98,176],"or":[66],"save":[67],"sufficiently":[68],"fully":[70],"finance":[71],"LTSS;":[72],"many":[73],"eventually":[75],"turn":[76],"Medicaid":[78,196],"help.":[80],"To":[81],"show":[82],"how":[83],"policy":[84,161],"changes":[85],"could":[86],"expand":[87],"insurance's":[88],"role":[89],"in":[90,112,165],"financing":[91],"needs,":[93],"we":[94,101],"modeled":[95,133],"several":[96],"new":[97],"options.":[99],"Specifically,":[100],"looked":[102],"at":[103],"front-end-only":[105],"benefit":[106,122],"that":[107,160],"provides":[108],"coverage":[109],"early":[111],"the":[113,155,169,178,186,190,198],"disability":[116],"but":[117],"caps":[118],"benefits,":[119],"back-end":[121,201],"no":[124],"lifetime":[125],"limit,":[126],"combined":[129],"comprehensive":[130,199],"benefit.":[131],"We":[132,150],"mandatory":[134,179,202],"voluntary":[136,148,187],"versions":[137,145],"each":[139,147],"option,":[140],"subsidized":[142],"unsubsidized":[144],"option.":[149],"identified":[151],"important":[152],"differences":[153],"among":[154],"alternatives,":[156],"highlighting":[157],"relevant":[158],"trade-offs":[159],"makers":[162],"can":[163],"consider":[164],"evaluating":[166],"proposals.":[167],"If":[168,189],"primary":[170],"goal":[171],"significantly":[174],"increase":[175],"coverage,":[177],"options":[180,203],"would":[181,204],"be":[182,205],"more":[183],"successful":[184],"than":[185],"versions.":[188],"major":[191],"aim":[192],"reduce":[195],"costs,":[197],"most":[206],"beneficial.":[207]},"counts_by_year":[{"year":2026,"cited_by_count":1},{"year":2025,"cited_by_count":3},{"year":2024,"cited_by_count":5},{"year":2023,"cited_by_count":3},{"year":2022,"cited_by_count":5},{"year":2021,"cited_by_count":6},{"year":2020,"cited_by_count":4},{"year":2019,"cited_by_count":6},{"year":2018,"cited_by_count":9},{"year":2017,"cited_by_count":5},{"year":2016,"cited_by_count":6}],"updated_date":"2026-11-07T11:25:07.637180","created_date":"2016-06-24T00:00:00"}