The Economics of Alzhemier's Disease / ADRD
Paper Session
Sunday, Jan. 3, 2027 8:00 AM - 10:00 AM (EST)
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Chairs:
Kathleen McGarry, University of California-Los Angeles and NBER - James Poterba, Massachusetts Institute of Technology and NBER
Disparities in Medicaid Managed Long-Term Services and Supports for Older Adults with ADRD: Evidence from Wisconsin
Abstract
This project investigates the effects of Medicaid managed care for long-term services and support (LTSS), comparing outcomes for both people living with dementia and those without dementia. The project focuses on Wisconsin, where a voluntary Medicaid managed LTSS program (Family Care) was gradually rolled out between 2000 and 2019. The project will explore differences in program adoption (relative to traditional Medicaid) across the population, differences in LTSS use before and after program implementation and, specifically, the causal effect of managed LTSS on the use of in-home and community-based services versus nursing home services.Living with Dementia: Mental Health and Mortality Effects on Spouses
Abstract
Alzheimer's disease and related dementias (ADRD) are among the costliest health conditions in high-income countries. The continuous care demands and neuropsychiatric symptoms of ADRD make it fundamentally a family disease, yet the health consequences for the spouse remain poorly quantified at the population level. We use population-wide administrative data from Denmark (1995–2018) and a matched event study design spanning 18 years around the ADRD spouse's death. We find gradual increases in mental health visits among non-ADRD spouses that peak around the time of spousal death, reaching three-fold the counterfactual level for both men and women. Psychiatric medication use increases by approximately 50% over the same period. These outcomes improve after the spouse's death, suggesting relief from sustained exposure rather than a permanent health shock. We also find that mortality risk rises for the non-ADRD spouse, with preliminary evidence pointing to mental and neurological causes of death. Because this excess mortality generates selective attrition, we use Lee bounds — a novel application in this setting — to provide informative bounds on the mental health effects. Our findings indicate that the family health costs of ADRD operate through sustained mental health deterioration over the disease trajectory rather than an acute bereavement shock.Long-Term Care Insurance for Dementia Patients: Evidence from Germany
Abstract
Many countries are expanding long-term care (LTC) systems in response to population aging, yet little is known about how the design of benefits affects care choices, health outcomes, and public spending. This paper studies a major reform to Germany’s universal LTC insurance program that expanded eligibility, especially for cognitive limitations, increased benefit generosity, especially for home and cash care, and equalized out-of-pocket prices for nursing home care. Using administrative claims data covering roughly 10% of the German population from 2013–2019, we implement a difference-in-differences framework based on predicted eligibility to estimate the reform’s effects on care utilization, mortality, and spending. We find that the reform substantially increased program entry and shifted care toward cash and home-based options, with corresponding reductions in nursing home use. These changes are accompanied by modest improvements in mortality but significant increases in total LTC and healthcare spending. We further exploit policy-induced variation in nursing home out-of-pocket prices to estimate the elasticity of institutional care demand. Higher prices reduce nursing home entry among community-based care users. Building on these facts, we develop a dynamic structural model of care choice to evaluate optimal subsidy design, highlighting trade-offs between fiscal costs and health outcomes in LTC systems.Discussant(s)
Karen Clay
,
Carnegie Mellon University
Alden Cheng
,
NBER
Gopi Shah Goda
,
Brookings Institution
Norma Coe
,
University of Pennsylvania
JEL Classifications
- I1 - Health
- H4 - Publicly Provided Goods