Aged-care support in Japan: perspectives and challenges

This article explores economic aspects of the market for long-term care (LTC) in Japan. As the world's most rapidly aging nation, it is of interest to understand that country's current LTC system and projections of LTC utilization patterns and costs, as well as their potential drivers. Since Japan appears likely to experience important shortfalls in LTC in the future, the authors also discuss alternate forms of provision.     

韩国老人长期看护保险法评介

为了应对人口高龄化带来的老人看护问题,韩国制定了《老人长期看护保险法》,通过该法创设了老人看护保险制度。该法的实施预示着韩国逐渐由家庭养老方式向社会化养老方式进行转变。尽管老人看护保险制度还面临一些新的问题,但韩国已经在解决高龄者看护问题的道路上迈出了坚实的一步。     

老龄危机背景下我国长期护理保险制度试点方案的比较与思考

通过梳理15个试点地区长期护理保险制度的实施方案,对参保对象、基金来源、给付对象、评定依据、服务项目、服务形式以及待遇支付等进行比较分析。以老龄危机为背景,深入思考与探讨长期护理保险制度参保对象的覆盖、给付对象的界定、筹资主体的确定、保障内容的提供等问题,同时提出了针对性建议:参保对象应延伸至农村;给付对象暂定为重度失能失智老年参保者;筹资主体做到真正多元化;服务项目以生活照料为主;待遇水平体现出对居家护理的支持;给付形式引入现金给付。     

互助保险机制在长期护理保障中的应用:典型案例的政策设计及绩效

自长期护理保险政策试点启动以来,部分地区以互助保险为基础架构的长期护理保险制度,在制度框架、筹资机制、支付范围、服务提供方式等方面均具有一定的创新性。基于北京市海淀区试点政策的评估表明,以自愿参保、同质群体风险分摊和收益分享为前提的互助保险机制不能兼顾保障公平性、可持续性和可负担性等多重目标。应坚持以社会保险为基础构建多层次长期护理保障体系,支持商业健康保险公司提供多层次、补充性的保险产品。同时,要做好医疗、养老服务体系的改革和衔接,充分发挥护理保险基金的保障功能和保障潜力。     

Deregulation,tax reform,and the use of consumer credit

This article analyzes the probable effects of recent deregulation of consumer credit markets and tax reform on household credit-use decisions. The results of the analysis suggest that deregulation of rates of charge for consumer credit contracts accounts for a substantial portion of the increase in consumer credit outstanding relative to household income since 1982. The effect would not originate from the extention of credit in newly deregulated markets to households that had not been able to get credit before (widening of credit use). Rather, it would come from the provision of greater amounts of credit to borrowers in general (deepening of credit use). With regard to tax reform, the probability of debt use is significantly higher for those households most likely to itemize deductions for federal income tax purposes. Holding the level of interest rates constant, tax reform that removes the deductibility of consumer interest is not expected to affect the amount of credit used relative to income but is expected to have a significant effect on the type of debt used by such households. They will likely be early adopters of home equity lines of credit. Their shift from consumer to mortage credit is expected to have a long-term negative effect on the credit quality of consumer credit portfolios.This work was partially supported by the Credit Research Center. Purdue University, West Lafayette, IN 47907.     

GOVERNMENT POLICY AND THE CHANGING MARKET IN RESIDENTIAL CARE FOR THE ELDERLY: A FINANCIAL ANALYSIS OF THE PRIVATE SECTOR

The market in residential care for the elderly is in a state of flux. Key factors are the increasing proportion of elderly (particularly the 85+ age group) and central governments new community care agenda. The mixed economy of public, private and voluntary residential provision will continue but community care policy changes will entail (a) the new role of case managers in the local authorities and (b) an anticipation that the private sector will play a more significant role than hitherto not only in meeting the demand for residential care but also in leading the way by diversifying into new types of care provision. These issues are addressed by (1) examining and commenting on government policy towards the care of the elderly and (2) examining, in detail, the profitability and financial viability of a random sample of private residential homes for the elderly. This financial analysis suggests that, at present, the ability of the private sector to innovate and expand into new forms of service provision is constrained by the number of homes which operate at the margins of viability. The implications of this are that (a) government policy may be founded on an optimistic view of the ability of private sector provision to respond as expected to the new community care agenda and (b) case managers in local authorities may have to exercise considerable financial expertise in identifying financial vulnerability, as well as social work skills, in the deployment of available funds for residential care for the elderly.     

Narrow Framing and Long-Term Care Insurance

We propose a model of narrow framing in insurance and test it using data from a new module we designed and fielded in the Health and Retirement Study. We show that respondents subject to narrow framing are substantially less likely to buy long-term care insurance than average. This effect is much larger than the effects of risk aversion or adverse selection, and it offers a new explanation for why people underinsure their later-life care needs.     

Lapses in long-term care insurance

About a quarter of long-term care insurance (LTCI) policy holders aged 65 let their policies lapse before death, forfeiting all benefits. We find that lapse rates are substantially higher among the cognitively impaired in the Health and Retirement Study. This generates a pernicious form of dynamic advantageous selection, as the cognitively impaired are more likely to use care. Simulations show that an inappropriately optimistic asset drawdown path further increases the individual welfare cost of unanticipated lapses. Meanwhile, we find evidence of a significant but very small role for either strategic or financial motives for lapsing.     

Determinants of Trading Profits: The Liquidity Provision Decision

Theories show that liquidity provision implies negative contemporaneous correlation between trades and returns. Dealers on the Taiwan Stock Exchange are granted typical dealer trading advantages without obligations to provide liquidity and, thus, are ideal to test whether these advantages lead to voluntary liquidity provision (earning bid-ask spreads) or information trading (trading in the direction of the market). We find a strong positive correlation in aggregate, implying that these unrestricted dealers prefer information trading. We also find that smaller dealers are more likely to provide liquidity and that small-cap stocks (with larger bid-ask spreads) are more profitable for liquidity provision.     

The Politics of Evidence-Based Health Policy-Making

Israel's National Health Insurance Law which came into effect in January 1995 required a substantial reform of the country's health-care system. Health care in Israel was decentralized, lightly regulated, dominated by politicised decisions, under-funded and inefficient. Health policy was poorly grounded in data and largely influenced by political considerations. The main thrusts of the reform were to universalize health insurance coverage, increase freedom of choice, depoliticize the system, stabilize the system financially, and decrease service provision by the state by transferring some responsibilities to 'sick funds' to be regulated by the Ministry of Health. Data were to play an important role in de-politicizing and making decision-making more rational. This article gives some encouragement to proponents of evidence-based policy-making but shows that, even where the intention is to use data, political motives are a strong force.     

Long‐Term Care Across Europe and the United States: The Role of Informal and Formal Care

Large cross‐country variation in long‐term‐care (LTC) policy in conjunction with household‐level data on caregiving provides a valuable laboratory for policy analysis. However, there is a lack of comprehensive cross‐country data on how care is provided. In order to close this gap, we draw on data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS) in the United States. Because care hours are missing for some care forms (especially for nursing‐home residents), we propose a selection model to impute these. The model allows selection into care forms to differ by country. Our estimates imply that nursing‐home residents have higher care needs, even when conditioning on observed characteristics. In contrast to the bulk of the literature, we also take into account care provision from persons in the same household, and we find that this contributes one‐third of all care hours. Informal‐care provision in Europe follows a steep North–South gradient, with the United States falling in between Central European and Southern European countries. The results are robust to alternative imputation schemes.     

A public good model with lotteries in large groups

We analyze the effect of a large group on a public goods model with lotteries. We show that as populations get large, and with preferences in which people only care about their private consumptions and the total supply of the public good, the level of contributions converges to the one given by voluntary contributions. With altruistic preferences of the warm-glow type, the contributions converge to a level strictly higher than those given by voluntary contributions, but in general they do not yield first-best levels. Our results are important to clarify why in general governments do not rely on lotteries for a large part of the revenue creation for public good provision. They are also useful to understand why lottery proceeds are earmarked to worthy causes, where warm glow is likely to be larger.     

日元汇率变动的影响因素及走势分析

2012年2月份以来,日元大幅贬值,市场对于日元是否已进人中长期贬值通道展开了热烈讨论,日元贬值论也甚嚣尘上。文章在分析导致日元历史与近期贬值趋势的影响因素的基础上,尝试对日元汇率的未来走势进行判断,指出在当前市场环境下,日元存在短期内温和贬值的可能,但尚未发现足以推动日元中长期贬值的市场力量,目前判断日元已进人中长期贬值通道还为时尚早。     

长期护理保险的家庭溢出效应研究综述及对我国的启示

家庭成员与老年人的护理选择有着复杂及重要的交互作用。本文回顾和梳理了国内外学术界关于长期护理保险家庭溢出效应的理论与实证研究成果,作为我国构建长期护理保险制度的参考,最后提出促进国内长期护理保险的建议。     

Information,belief elicitation and threshold effects in the 5X1000 tax scheme: a framed field experiment

In this paper, we study by means of a framed field experiment on a representative sample of the population the effect on people’s charitable giving of three, substantial and procedural, elements: information provision, belief elicitation and threshold on distribution. We frame this investigation within the 5X1000 tax scheme, a mechanism through which Italian taxpayers may choose to give a small proportion (0.5%) of their income tax to a voluntary organization to fund its activities. We find two main results: (i) providing information or eliciting beliefs about previous donations increases the likelihood of a donation, while thresholds have no effect; (ii) information about previous funding increases donations to organizations that received fewer donations in the past, while belief elicitation also increases donations to organizations that received most donations in the past, since individuals are more likely to donate to the organizations they rank first.     

Contract Type and the Cost of Provision: Evidence from Maintenance Service Contracts*

More than half a billion dollars are spent each year on the maintenance of Australia's urban water and sewerage networks. Expenditure is governed through a mix of in‐house and outsourced maintenance service contracts. We re‐examine issues relating to the relationship between the cost of maintenance service provision and the type of contract used. We take advantage of the fact that water retailers in Melbourne use a mix of contract types – including fixed‐price (FP) and cost‐plus (C+) contracts – for the provision of water and sewerage network maintenance services. Our results suggest that the C+ contract results in substantial savings.     

Social long-term care insurance and redistribution

We study the role of social long-term care (LTC) insurance when income taxation and private insurance markets are imperfect. Policy instruments include public provision of LTC as well as a subsidy on private insurance. The subsidy scheme may be linear or nonlinear. For the linear part we consider an arbitrary number of types, characterized by earnings and survival probabilities. In the nonlinear part, society consists of three types: poor, middle class and rich. The first type is too poor to provide for dependence; the middle class type purchases private insurance and the high income type is self-insured. The main questions are at what level LTC should be provided to the poor and whether it is desirable to subsidize private LTC for the middle class. Interestingly, the results are not totally similar under both linear and nonlinear schemes. First, whereas in the linear case a subsidy of private LTC insurance is desirable, it is not in the nonlinear case (at least at the margin). Second, the desirability of public provision of LTC services depends on the way the income tax is restricted. In the linear case, it may be desirable only if no demogrant (uniform lump-sum transfer) is available. In the nonlinear case, public provision is desirable when the income tax is sufficiently restricted. Specifically, this is the case when the income is subject only to a proportional payroll tax while the LTC reimbursement policy can be nonlinear.     

Road Funds, User Charges, and Taxes

Insufficient or uncertain budgetary allocations to road maintenancehave resulted in road deterioration that has significantly increasedproduction and transport costs in many countries. To avoid thisproblem, highway proferssionals advocate the establishment ofdedicated road funds, managed by independent road boards madeup of user representatives. The road boards would have the powerto determine both the level of charges for road use and thelevel of expenditure on road maintenance. By contrast, macroeconomistsand public finance specialists have tended to resist the establishmentof dedicated road funds. They argue that road funds reduce fiscalflexibility, do not adequatedly address problems associatedwith the provision of public goods or the internalization ofexternalities, and often are not well managed. In general, there are two long-term institutional options forreconciling fiscal prudence with asset maintenance; a road agencythat is operated commercially (subject to the normal oversightof behavior accorded to privatized monopolies), or a reformedand well-functioning budget process. This article argues thatroad funds must be viewed as a provisional, case-specific intermediatestep in the direction of one of the long-term solutions. Therole and nature of road funds should be assessed not on generalprinciples but on a case-by-case basis through the analysisof likely micro-and macroeconomic effects. The article recommendsindicatiors for use in specific cases to determine whether aroad fund should be introduced, continued, or abolished.      

The supply of charity services by nonprofit hospitals: motives and market structure

This article studies provision of charity care by private, nonprofit hospitals. We demonstrate that in the absence of large positive income effects on charity care supply, convex preferences for the nonprofit hospital imply crowding out by other private or government hospitals. Extending our model to include impure altruism (rivalry) provides a possible explanation for the previously reported empirical result that both crowding out and income effects on indigent care supply are often weak or insignificant. Empirical analysis of data for hospitals in Maryland provides evidence of rivalry on the supply of charity care.