Diverging Mortality Inequality Trends among Young and Old in the Netherlands*

We analyse the trends in inequality in mortality across poverty groups at different ages over the period 1996–2016 in the Netherlands. In addition, we examine whether these trends are related to unequal changes in avoidable mortality, separated by preventable and treatable causes of death. We find that while inequalities in mortality have decreased at ages up to 65, inequalities increased for the oldest age groups. The decline in inequality at the younger ages can, to a large extent, be explained by a strong decrease of mortality from preventable and cardiovascular causes among the poor. The link between inequality and avoidable mortality at the oldest ages is less straightforward. The increasing inequality at old age might be the result of the inequalities shifting from the young to the older age groups, or of the rich benefiting more from the recent health (care) improvements than the poor.     

Mortality Inequality in England over the Past 20 Years*

In this paper, we study the evolution of age‐group‐ and gender‐specific mortality and mortality inequality in England between 2003 and 2016, by comparing small geographic areas ranked by deprivation and grouped into bins of similar population size. We show that across all age groups, but especially in the older age groups (65+), there has been a clear and significant reduction in rates of mortality since 2003. In spite of these improvements, we continue to see significant inequalities in mortality across most age groups in 2016 and evidence of rising inequalities among women in the 65+ and men in the 80+ age groups. Furthermore, we see a striking stalling of the downwards trend in mortality and mortality inequality observed between 2003 and 2010 during the years of economic austerity in the aftermath of the 2008 financial crisis in England between 2010 and 2016. Analysis of specific causes of death among adults aged 20–79 allows us to examine the drivers and dynamics of these trends in more depth, as well as to consider scope for, and types of, interventions that would be appropriate at different ages.     

Inequality in Mortality in Spain*

We analyse the evolution of mortality rates in Spain by age and gender between 1990 and 2018. We compare municipalities, ranked by socio‐economic status (SES) and grouped into bins of similar population size, to study changes not only in levels but also in inequality in mortality across the SES spectrum. We document large decreases in mortality rates throughout the period for all age groups, including children, even after 2000, and continuing after the Great Recession. These declines are stronger for boys and men, who had higher mortality rates to begin with. We find that inequality in mortality across municipalities was low among the young by 2018, while it was higher among adult men and older women. Inequality in fact increased over the period for older men. We explore the role of different causes of death and find that this increase in inequality is driven by stronger improvements in cancer‐related mortality among men living in richer areas. These improvements are not found among women, given their increases in mortality due to lung cancer.     

Geographic Inequality in Income and Mortality in Germany*

We use data from the German Federal Statistical Office on population counts, births, deaths and income to study the development of socio‐economic inequality in mortality rates from 1990 to 2015 for different age groups and both genders. Ranking the 401 German districts by average disposable income per capita, we observe large inequalities in district‐level mortality rates in 1990, which had almost disappeared, or at least been flattened considerably, by 2015 particularly for infants, children and the very old. The most important driver of this reduction in inequality is German reunification in 1990. As indicated by more detailed analyses comparing districts in the former East and the former West, even five years after reunification there was a large gap in disposable income, with all Eastern districts considerably poorer than the poorest district in the West. At the same time, mortality rates were higher for all age groups and both genders in the East. Income has caught up, to the extent that there are equally poor districts in the East and West in most recent years (although the West is still much richer on average). Mortality rates in the East have improved considerably and are even below mortality rates for similarly poor districts in the West in the most recent data.     

Mortality Inequality in Finland*

We study inequality in mortality in Finland using registry data that cover the whole population for years 1990–2018. We create municipality‐level indices of regional deprivation (poverty rate), and show how age‐specific mortality rates have evolved across regions and over time. The inequality in mortality has been remarkably low over the time period for most age groups. However, among young and prime‐age males, the mortality rates have been persistently higher in the poorer areas. For these age groups, the leading causes of death are deaths of despair (alcohol and suicides) and accidents. For the cohorts that were young during the deep recession of the early 1990s, we also document higher inequality in middle‐age mortality than for cohorts entering the labour market in recovery periods.     

COVID-19 and Ethnic Inequalities in England and Wales*

The economic and public health crisis created by the COVID-19 pandemic has exposed existing inequalities between ethnic groups in England and Wales, as well as creating new ones. We draw on current mortality and case data, alongside pre-crisis labour force data, to investigate the relative vulnerability of different ethnic groups to adverse health and economic impacts. After accounting for differences in population structure and regional concentration, we show that most minority groups suffered excess mortality compared with the white British majority group. Differences in underlying health conditions such as diabetes may play a role; so too may occupational exposure to the virus, given the very different labour market profiles of ethnic groups. Distinctive patterns of occupational concentration also highlight the vulnerability of some groups to the economic consequences of social distancing measures, with Bangladeshi and Pakistani men particularly likely to be employed in occupations directly affected by the UK's ‘lockdown’. We show that differences in household structures and inequalities in access to savings mean that a number of minority groups are also less able to weather short-term shocks to their income. Documenting these immediate consequences of the crisis reveals the potential for inequalities to become entrenched in the longer term.     

Inequality in Mortality: Updated Estimates for the United States,Canada and France*

This study provides comparisons of inequalities in mortality between the United States, Canada and France using the most recent available data. The period between 2010 and 2018 saw increases in mortality and in inequality in mortality for most age and gender groups in the United States. The main exceptions were children under 5 and adults over 65. In contrast, Canada saw a further flattening of mortality gradients in most groups, as well as further declines in overall mortality. The sole exception was Canadian women over 80 years old, who saw small increases in mortality rates. France saw continuing improvements in mortality rates in all groups. Both Canada and France have distributions of mortality that are much more equal than those in the United States, demonstrating the importance of public policy in the achievement of equality in health.     

中国区际公共卫生服务水平差异的变化:运用泰尔指数的测度方法

缩小因地区差异导致的公共卫生服务水平差距,对我国统筹区域社会经济发展、构建和谐社会具有重要意义.基于我国地区间公共卫生服务差异化的现实,本文运用泰尔指数对中国公共卫生服务水平的均等化问题进行了实证分析,结果表明三大区域虽然非均等化在不同程度上存在,但近几年地区之间的差异总体上有所缩小.并提出了新时期我国公共卫生服务均等化和财政体制改革的建议,为构建公共卫生资源在地区间的和谐分配、推进公共卫生服务均等化战略提供一个理论和政策的有力支撑.     

Immediate Annuity Pricing in the Presence of Unobserved Heterogeneity

Abstract

One of the acknowledged difficulties with pricing immediate annuities is that underwriting the annuitantis life is the exception rather than the rule. In the absence of underwriting, the price paid for a life-contingent annuity is the same for all sales at a given age. This exposes the market (insurance company and potential policyholder alike) to antiselection. The insurance company worries that only the healthiest people choose a life-contingent annuity and therefore adjust mortality accordingly. The potential policyholders worry that they are not being compensated for their relatively poor health and choose not to purchase what would otherwise be a very beneficial product.

This paper develops a model of underlying, unobserved health. Health is a state variable that follows a first-order Markov process. An individual reaches the state “death” either by accident from any health state or by progressively declining health state. Health state is one-dimensional, in the sense that health can either “improve” or “deteriorate” by moving farther from or close to the “death” state, respectively. The probability of death in a given year is a function of health state, not of age. Therefore, in this model a person is exactly as old as he or she feels.

I first demonstrate that a multistate, ageless Markov model can match the mortality patterns in the common annuity mortality tables. The model is extended to consider several types of mortality improvements: permanent through decreasing probability of deteriorating health, temporary through improved distribution of initial health state, and plateau through the effects of past health improvements.

I then construct an economic model of optimal policyholder behavior, assuming that the policyholder either knows his or her health state or has some limited information. the value of mortality risk transfer through purchasing a life-contingent annuity is estimated for each health state under various risk-aversion parameters. Given the economic model for optimal purchasing of annuities, the value of underwriting (limited information about policyholder health state) is demonstrated.     

城乡居民医保逆选择的破解——一个基于不同人口年龄需求的设计

逆选择困扰了我国城乡居民医保事业的可持续发展.在原有的大病和重病保障之外,基于不同人口年龄需求设计一个有条件、有限度和有年龄差别的特殊医保待遇方案,让参保者在没有享受到大病重病医保待遇的情况下,也可获得一些与年龄相称的医保待遇.这一设计除了能增加参保的弹性,让各年龄群体都自愿积极参保,还可增强居民的健康意识,提高居民的健康水平,减少居民和医保的医药开支.此外,它还能促进基层医疗服务业的发展.