The Longitudinal Impact of Private Health Insurance on the Usage of Outpatient Services Among Aging Koreans

Abstract South Korea has a universal national health insurance system; however, its coverage is only about 65%. Consequently, many Koreans have supplemental private health insurance. This study aims to examine 1) how utilization of health care services and out-of-pocket expenditure of outpatient services varies by private health insurance status and 2) whether this relationship changes for these individuals over time. We analyze six waves of the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016. Our primary outcomes of interest are the total number of outpatient visits and total out-of-pocket spending on outpatient services per year. Our independent variable of interest is private health insurance holding status. We use simple OLS regressions for each year to test if differences exist and change over time, controlling for age, sex, education, income, and various indicators of health conditions. The difference between those who never had private health insurance and those who always or sometimes had private health insurance becomes larger over time. When comparing total out-of-pocket expenditure, those who always had private health insurance have the lowest spending at the beginning of the study period (2006); however, their spending increases sharply by 2010 and remains higher than the other groups for the rest of the study period. Findings suggest that those who always had supplemental insurance use outpatient services more frequently and spend more out-of-pocket for services as a result. In addition, discrepancies become larger over time. As private health insurance holders age, the risk of higher utilization of outpatient services grows.

Influencing health policy change is a significant focus for scholars and clinicians in the aging field. Nevertheless, they seldom receive formal training on how to influence the policymaking process effectively or how to translate their clinical and research experiences to inform policymakers best. Exposing scholars and clinicians to the policymaking process can advance their effectiveness as they seek to realize meaningful change to promote healthy aging of our population. This poster presentation focuses on providing scholars and clinicians with strategies to understand and influence the federal policymaking process. The presentation addresses the current policy environment in which federal health and aging policy is made and describes challenges to this process. Four strategies are identified to help scholars and clinicians influence the policymaking process: 1) identify a problem and any relevant policy that corresponds to the issue, 2) identify evidence-based solutions that relate to quality improvement, population health, or reducing per capita cost of healthcare, 3) grow relevant networks, meet experts, build relationships and connect with key stakeholders, 4) identify potential unintended consequences or barriers to the implementation of policy. By providing examples, this how-to aging and health policy road map provides context and guidance to stakeholder engagement, frameworks, and methods that can be used to engage in the policymaking process. The final part of this presentation explores ways to integrate health policy training and experience into scholars' and clinicians' professional development.

SIMULATING THE EFFECTS OF CONSTRUCTION IN NYC'S CHINATOWN ON FRUIT AND VEGETABLE CONSUMPTION IN LOCAL RESIDENTS
Stella Yi, 1 Yan Li, 2 Valerie Imbruce, 3 Yi-Ling Tan, 1 Victoria Foster, 1 Vivian Wang, 4 and Simona Kwon, 1 1. NYU School of Medicine,New York,New York,United States,2. Icahn School of Medicine at Mount Sinai,New York,New York,United States,3. Binghamton University,Binghamton,United States,4. NYU School of Global Public Health,New York,New York,United States In 2017, the mayor of New York City (NYC) unveiled a 10-year plan to close the city's largest jail complex and to build four satellite detention centers -including one in Manhattan's Chinatown. Chinatown is a destination for affordable produce and its retail produce sector is comprised of street vendors and small stores, a style of fresh fruit and vegetable (FV) marketing the city promotes to achieve its goal of equitable access to healthy foods. The objective of this study was to project the impact of the proposed construction activity on FV consumption among residents in Chinatown. We developed an agent-based model that accounts for individual and neighborhood-level factors (e.g., age, gender, education, food environment) to predict FV consumption at the neighborhood level in NYC. We assumed that long-term construction will lead to the closure/migration of fresh produce vendors and therefore a reduction of FV access. We simulated three scenarios in which the number of fresh produce vendors is reduced by 5%, 10%, and 15% due to construction. Results suggest that planned construction could decrease the consumption of FV by 2.1%, 4.4%, and 6.8% among residents in Chinatown if the construction would reduce the number of fresh produce vendors by 5%, 10%, and 15%, respectively. Preliminary sensitivity analyses demonstrate the negative impact of the construction on FV consumption could be greater among older (65+ years) vs. young adults. The planned construction of a detention center in Chinatown may decrease the consumption of FV among its residents, particularly older adults.

THE FAMILY AND MEDICAL LEAVE ACT: A POLICY ANALYSIS AND RECOMMENDATIONS TO ADDRESS EMPLOYED CAREGIVER BURDEN Geunhye Park, and Erin Robinson, University of Missouri-Columbia, Columbia, Missouri, United States
Family caregiving plays a pivotal role in the long-term care system in the U.S, as there are over 40.4 million people providing unpaid care to individuals aged 65+ (U.S. Bureau of Labor Statistics, 2019). The majority are women providing supports to a parent/grandparent and provide an average of three hours of care each day. This places greater demands on family caregivers in balancing their dual caregiver/employment roles. The Family and Medical Leave Act (FMLA) of 1993 enables family caregivers to take unpaid leave to provide supports to immediate family. While FMLA was intended to provide flexibility to employed caregivers, many struggle with family-work conflicts and caregiver burden is high. Therefore, this conceptual paper offers a critical examination of FMLA and how family caregivers of older adults are impacted. Results of this analysis revealed three themes. First, FMLA is largely inadequate for employed caregivers, as only 60% of the workforce are eligible and unpaid leave restrictions create considerable financial hardship. Second, employer discrimination is high and family caregiving discrimination claims have dramatically increased since FMLA was enacted. And third, many employed caregivers are unaware of FMLA policies and eligibility requirements, which results in underutilization of benefits. Based upon these results, several policy and employer recommendations can be made, such as expanding FMLA coverage to include paid leave and non-immediate family caregivers. Additional recommendations will also be addressed. As it has been nearly 30 years since FMLA was enacted, updated policy is vital to continue supporting employed caregivers in their roles.

THE LONGITUDINAL IMPACT OF PRIVATE HEALTH INSURANCE ON THE USAGE OF OUTPATIENT SERVICES AMONG AGING KOREANS Narae Kim, University of Southern California, Los Angeles, California, United States
South Korea has a universal national health insurance system; however, its coverage is only about 65%. Consequently, many Koreans have supplemental private health insurance. This study aims to examine 1) how utilization of health care services and out-of-pocket expenditure of outpatient services varies by private health insurance status and 2) whether this relationship changes for these individuals over time. We analyze six waves of the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016. Our primary outcomes of interest are the total number of outpatient visits and total out-of-pocket spending on outpatient services per year. Our independent variable of interest is private health insurance holding status. We use simple OLS regressions for each year to test if differences exist and change over time, controlling for age, sex, education, income, and various indicators of health conditions. The difference between those who never had private health insurance and those who always or sometimes had private health insurance becomes larger over time. When comparing total out-of-pocket expenditure, those who always had private health insurance have the lowest spending at the beginning of the study period (2006); however, their spending increases sharply by 2010 and remains higher than the other groups for the rest of the study period. Findings suggest that those who always had supplemental insurance use outpatient services more frequently and spend more out-of-pocket for services as a result. In addition, discrepancies become larger over time. As private health insurance holders age, the risk of higher utilization of outpatient services grows.

TRENDS IN HEARING AID USE AMONG OLDER ADULTS IN THE UNITED STATES, 2011-2018
Nicholas Reed, 1 Emmanuel Garcia Morales, 2 and Amber Willink, 3 1. Johns Hopkins University, Baltimore,Maryland,United States,2. Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland,United States,3

. The University of Sydney, Sydney, New South Wales, Australia
Hearing loss among older adults is prevalent and associated with dementia and health care utilization. However, cross-sectional data suggest less than 20% of adults with hearing loss use hearing aids. There is a paucity of studies examining trends in hearing aid ownership over time. This study analyzed data from the 2011, 2015, and 2018 cycles of the National Health Aging and Trends Study (NHATS), a nationally-representative longitudinal study of Medicare Beneficiaries. Participants were asked "in the last month, [have you/has [he/she]] use a hearing aid or other hearing device?" ("yes" or "no"). Among a weighted sample of Medicare Beneficiaries 70 years and older (26.47 million in 2011; 29.70 million in 2015; and 33.28 in 2018), the overall proportion who own and use hearing aids rose from 14.96% in 2011 to 16.90% in 2015 to 18.45% in 2018. As age increased so did the proportion of older adults who used hearing aids. A smaller proportion of Black Americans used hearing aids across time and experienced a smaller overall increase in the proportion in hearing aid ownership over the 8-year period compared to White Americans (+0.78% vs. +4.30%). Black women had the lowest rates of hearing aids use across the 8-year period. Notably, older adults at less than 100% of the federal poverty level experienced an overall decrease in proportion of hearing aid ownership and use. This study lays the groundwork to examine the impact of the Over-the-Counter Hearing Aid Act of 2017 across subpopulations when it takes effect in 2021.

TRENDS IN MORTALITY IN PUERTO RICO BETWEEN 1979 AND 2018: AN ANALYSIS OF THE PUERTO RICO HEALTHCARE REFORM Alexis Santos, Pennsylvania State University, University Park, Pennsylvania, United States
Between 1993 and 2000, the Government of Puerto Rico decided to transform the role of the government from a provider of healthcare to an insurer. Despite claims about the success of the reform, no study has assessed whether it improved the health of the population or reduced mortality. The aim of this study is to assess whether the implementation of the Puerto Rico Healthcare Reform of 1993 reduced mortality and infant mortality in Puerto Rico in a significant way. I calculated crude death rates (CDR), agestandardized death rates, infant mortality rates, total deaths and life expectancy between 1980 and 2018. I used a quasiexperimental design to study the effect of the implementation of the Puerto Rico Healthcare Reform on these indicators. The primary objective was to estimate changes in trends after 2000. The Age-Specific Mortality Rates have reduced since 1980. The least pronounced change for 2018, in comparison to 1980, was for young adults (20-24 years, 25-29 years, and 30-34 years). The CDR was affected based on the implementation of the reform, but the Infant Mortality Rates was not. The Standardized Death Rate and deaths indicate that there was a small reduction in these indicators. I also found that the gains in life expectancy were concentrated in older adults (aged 65 and older). Analysis of all-cause mortality indicators allows for the evaluation of this healthcare reform. The reduction in mortality in the post-2000 period was not entirely due to the trend that existed before the healthcare reform was implemented.

A SCOPING REVIEW OF HOW FINANCIAL HARDSHIP IS MEASURED AMONG OLDER ADULTS IN THE UNITED STATES
Reginald Tucker-Seeley, 1 Ryan DoyLoo, 2 and Leora Steinberg, 1 1. University of Southern California,Los Angeles,California,United States,Malibu,California,United States The association between socioeconomic status and health/healthcare related outcomes across the life course is well established; however, the specific mechanisms that underlie this complex association are not well understood. There have been calls in the health disparities literature for greater explication of the socioeconomic factors associated with differential outcomes for racial/ethnic minorities and socioeconomic groups. Recent research offers an expanded notion of socioeconomic circumstances by including indicators of financial hardship; however, there has been little conceptual and measurement clarity for gerontology research. To fill this gap, we conducted a scoping review of how financial hardship has been defined and measured in research with older adults. Using an adapted version of the Preferred Reporting Items for Systematic reviews and Meta-Analyses