Long‐term care and intrafamily moral hazard: Optimal public policy

The paper studies optimal public long‐term care (LTC) policy in the context of intrafamily moral hazard suggested by Pauly. The model considers a representative family consisting of an adult child and her elderly parent who might become dependent, in which case he places a special value on the LTC provided to him by his child. Since the child's caregiving is decreasing in the amount of insurance coverage, the parent prefers to underinsure, which is socially suboptimal. The child's choice of caregiving is also inefficient since she does not internalize its positive effect on the parent. The paper tackles these inefficiencies and shows that intrafamily moral hazard is a sufficient justification for public intervention targeted at insurance. If not necessarily for the introduction of mandatory public insurance, then at least for the taxation or subsidization of private insurance premiums.     

Opting out and topping up reconsidered: Informal care under uncertain altruism

We study the design of public long‐term care (LTC) insurance when the altruism of informal caregivers is uncertain. We consider non‐linear policies where the LTC transfer depends on the level of informal care, which is assumed to be observable, while children's altruism is not. Our policy encompasses two policies traditionally considered in the literature: topping up policies consisting of a transfer independent of informal care, and opting out policies entailing a positive transfer only if children fail to provide care. We show that both total and informal care should increase with the children's level of altruism. This is obtained under full and asymmetric information. Public LTC transfers, on the other hand, may be non‐monotonic. Under asymmetric information, public LTC transfers are lower than their full information level for the parents whose children are the least altruistic, while it is distorted upward for the highest level of altruism. This is explained by the need to provide incentives to highly altruistic children. In contrast to both topping up and opting out policies, the implementing contract is always such that social care increases with informal care.     

Optimal long-term care policy in an intergenerational exchange setting

We examine the optimality of public long-term care policy, incorporating an exchange game between elderly parents and adult children and transfer-seeking competition among siblings, instead of children's altruism. Results reveal that when children compete to obtain more valuable bequests from parents in exchange for elderly care, public long-term care policy is optimal if government can provide long-term care more efficiently than children can, thereby reducing parental bequests, possibly to zero. This is likely to be the case when children's wages are high. Formal long-term care might not be necessary if parents can receive adequate informal care in exchange for bequests to children with low wages.     

Long‐term care policy with lazy rotten kids

This paper studies the determination of informal long‐term care (LTC) provided by children in a scenario which is somewhere in between perfect altruism and selfish exchanges. Parents are altruistic but children are purely selfish, and neither side can make credible commitments. The model is based on Becker's “rotten kid” specification except that it explicitly accounts for the sequence of decisions. In Becker's world, with a single good efficiency is achieved. We show that when family aid is introduced the outcome is likely to be inefficient. Still, the rotten kid mechanism is at work and ensures that a positive level of LTC is provided as long as the bequest motive is operative. We identify the inefficiencies by comparing the laissez‐faire (subgame perfect) equilibrium to the first‐best allocation. We first assume that families are identical ex ante and then consider the case where dynasties differ in wealth. We study how the provision of LTC can be improved by public policies. Interestingly, crowding out of private aid by public LTC is not a problem in this setting. With an operative bequest motive, public LTC will have no impact on private aid. More amazingly still, when the bequest motive is (initially) not operative, public insurance may even enhance the provision of informal aid.     

Tax subsidies,the rational demand for insurance and the health care crisis

An individual's optimal insurance coverage depends on balancing his gain through avoiding risk against his loss through the distortion of demand. The U.S. tax system subsidizes the purchase of excessive health insurance by excluding employer premium payments from employees' taxable incomes and by permitting the deduction of a portion of individual premiums. The current operational model of demand for health insurance shows that the tax subsidy does substantially increase insurance coverage. Since much of the rise in health care costs can be attributed to the growth of insurance, the tax subsidy is responsible for much of what is widely perceived as a health care crisis.     

Age-related taxation of bequests in the presence of a dependency risk

This paper studies the properties of the optimal taxes on bequests when individuals differ in wage and in their risks of mortality and old-age dependance. Survival is positively correlated to income but dependency is negatively correlated with it. The government cannot distinguish between bequests motives, that is whether bequests resulted from precautionary reasons or from pure joy of giving reasons. Instead, it observes the timing of bequests and the health status at death. Under the utilitarian social welfare criterion, we show that bequests taxation results from a combination of equity, insurance, and public revenue motives. If redistribution concerns dominate insurance concerns, it is desirable to tax the most bequests of those individuals living long in good health and to tax the least bequests of those dying early. This is a direct consequence of the socio-demographic structure we assumed where richer agents live longer and in better health than poorer agents. To the opposite, if insurance concerns dominate redistributive concerns, early bequests should be the most taxed and, bequests under dependency the least taxed. Under the Rawlsian criterion, we find that early bequests should be the least taxed and bequests left by the healthy long-lived individuals should be the most taxed.     

Child care voucher and labour market behaviour: experimental evidence from Finland

This article provides experimental estimates of the impact of a voucher for private care on labour force participation and use of private and public child care within the Nordic system of universal provision of public care. In a market that was providing high-quality, low-cost public child care, a voucher is nevertheless found to have a significant, positive effect for the use of private child care with zero effects on either use of public care or labour force participation. The use of private increased by five percentage points in the whole country and by five to seven percentage points in areas that suffer from excess demand for child care as a result of the introduction of the private child care voucher.     

Age- and health-related non-linear inheritance taxation

This paper studies the design of optimal non linear bequest taxation when individuals differ in wage, survival and probability to become dependent at the old age. Following the recent health and economic literature, we assume that agents with higher wage have higher survival chances and lower risks to become dependent. Agents make precautionary savings for their old age taking into account the uncertainty on their health. They exhibit joy of giving utility, so that they also set aside money for their heirs. In the absence of annuity and long-term care (LTC) insurance markets, heirs obtain different levels of bequests, depending on whether the donor died early or late in life and whether he was healthy at time of death. We assume that the government does not observe the decomposition of bequests between voluntary and involuntary ones. Instead, it observes the timing of death and the health condition at death of the donor. We show that, under asymmetric information, on top of marginal income taxation, the bequests left by low-income individuals in case of early death should be taxed at the margin. To the opposite, bequests obtained later in life need not be taxed or subsidized at the margin.     

Are Australia's tourism markets converging?

Many governments in low-income countries have promoted voluntary health insurance schemes in recent years, with the principal aim of improving access to services amongst those working in the informal economy. Few attempts to understand demand for such schemes exist, particularly in light of the importance of informal social security arrangements for many households. A model of demand for health insurance is developed reflecting this context, and estimated using data from Vietnam. The results show that informal financial networks may crowd out government promoted health insurance. Implications for theory and policy are discussed.     

The consumption tax in the presence of altruistic cash and human capital bequests with endogenous fertility decisions

We provide an analysis of the consumption tax policy in the presence of cash bequests, human capital investments in children, and endogenous fertility decisions. It is shown that the consumption tax is no longer neutral if the tax rate is constant over the taxpayer's life cycle, labor supply is exogenous, and the parent expects the offspring to pay the same tax rate, if the number of children is chosen optimally by the parent. Neutrality breaks down because the shadow prices of both bequests and fertility are interlinked; it is more expensive to produce a child the larger either bequest is and it is more expensive to make a bequest of either type to each child the larger the number of children produced. Several examples are provided where imposing the consumption tax induces an increase in the number of children produced and a decrease in net capital formation.     

Impact of government intervention in the housing market: evidence from the housing purchase restriction policy in China

In 2010, a housing purchase restriction policy was announced by China’s central government and implemented gradually by several prefecture governments. In this article, we empirically investigate this policy’s effect on the housing market. Using a difference-in-difference framework, we show that the housing purchase restriction policy reduces housing prices and transaction amounts but does not influence the housing investment or construction markets. Moreover, upstream industry suffers more than downstream industry. The results are robust to a battery of robustness checks. Heterogeneity exists across cities. We find that first- and second-tier cities as well as highly urbanized cities experience great declines in housing prices after the policy’s implementation, especially cites that had high housing prices in 2010 and cities with high real estate investment as a proportion of fixed asset investment. However, the housing policy is less effective in curbing speculative demand.     

ON THE CONSUMPTION TAX AND THE TAX TREATMENT OF BEQUESTS IN DIFFERENT MODELS OF BEQUEATHING BEHAVIOUR*

The tax treatment of bequests under the consumption tax policy is studied in two models of bequeathing behaviour, a model where the parent cares about the bequest itself and a model where the parent cares about the welfare of his offspring instead. It is shown that the two models make precisely opposite predictions of the effects of the consumption tax including the conditions under which the tax is neutral, the differential incidence of the tax in a closed economy when it is non-neutral, and the international transmission effect of the tax when it is non-neutral.     

财政波动风险与保险平滑机制：以地震灾害救助为例

文章基于我国重大地震灾害易引起财政剧烈波动的现实背景，借鉴国际上普遍采用的保险机制替代财政救灾的方式，根据我国地震相关历史数据，通过构建地震灾害财政救灾支出负担的积累模型，模拟了在不同保险金额下2014－2020年我国地震灾害财政积累救灾支出负担的变动情况，并以此检验保险如何平滑财政波动风险的事例。研究结果表明：政府购买保险可以有效地平滑财政救灾支出的波动性风险，且波动性与保险赔付呈反向关系。在98％的置信区间与10％的赔付率下，100亿元保额的地震保险可以使财政积累救灾负担的上下界各有08．％和12．％的下降，而1000亿元保额则可以基本消除财政救灾支出的波动性风险。文章研究表明，建立巨灾保险制度可以促进我国经济的稳定运行，有助于政府优化灾害管理、提高救灾效率、发挥市场功能和尽快建立巨灾保险体系。     

Gifts,bequests and family incentives

In this note, we use the theory of incentive contracting to characterize the pattern of financial transfers within the family. Using an altruistic model based on bounded rationality with one parent and two children, we show that the parent may provide a lower gift to the less well-off child, while bequests are always compensatory.     

On the value of Medicaid in providing access to long‐term care

The crowding‐out by Medicaid has been identified as a possible reason for the low demand for private long‐term care (LTC) insurance in the USA. I extend the previous analysis to the case in which budget constraints inhibit access to care. This reduces the role of the implicit tax and fundamentally changes the nature, scope, and welfare implications of crowding‐out. It suggests a large value of Medicaid that a private insurance market is unable to offer due to a dilemma prevalent in—but not exclusive to—the market for LTC insurance: a dilemma between access and affordability.     

Do estate and gift taxes affect the timing of private transfers?

Proposals to alter the estate tax are contentious and have been considered largely in an empirical vacuum. This paper examines time series and cross-sectional variation to identify the effects of estate and gift taxation on the timing of private transfers. The analysis is based on data from the 1989, 1992, 1995, 1998, and 2001 Surveys of Consumer Finances. Legislative activity during this period reduced the tax disadvantage of bequests relative to gifts. Moreover, the magnitude of this reduction differed systematically across identifiable household categories. We find that households experiencing larger declines in the expected tax disadvantages of bequests reduced inter vivos transfers relative to households experiencing small declines in the tax disadvantages of bequests. This finding is consistent with the hypothesis that the timing of transfers is responsive to applicable gift and estate tax rates. The results also provide evidence of a systematic bequest motive for high-wealth households.     

Tax incentives and the decision to purchase long-term care insurance

This paper studies the impact of the tax incentive prescribed in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on individuals' long-term care insurance purchasing behavior. Using data from the Health and Retirement Study, we find that the tax incentive in HIPAA increased the take-up rate of private LTC insurance by 3.3 percentage points, or 25%, for those eligible. Despite this seemingly strong response, our results imply that even an above-the-line tax deduction would not increase the coverage rate of seniors beyond 13%, indicating that tax incentives alone are unlikely to expand the market substantially. We also present, to our knowledge, the first estimate of the price elasticity of demand for LTC insurance of around ? 3.9, suggesting that demand is highly elastic at the current low ownership rate. Finally, we evaluate the net fiscal impact of the tax incentive and find that the tax deductibility of LTC insurance premiums leads to a net revenue loss for the government, as the reduced tax revenue from granting the tax incentive exceeds the savings in Medicaid's LTC expenditures.     

The Demand for Private Medical Insurance in the UK: A Cohort Analysis

This paper examines the determinants of the demand for private health insurance in the United Kingdom from 1978 to 1996 using a pseudo-cohort panel. The focus is on the impact of public and private sector quality, generational change, and past purchase on demand. The results indicate that there has been generational change in buying behaviour, that the number of senior doctors employed in the public sector impacts upon demand for the private alternative, and that there is limited impact of habit in purchase. Changes to the structure of labour contracts in the NHS may affect demand for the private alternative.     

Public versus private demand for covering long-term care expenditures

This article studies the determinants of the Willingness to Pay (WTP) for Long-Term Care (LTC) insurance coverage. Two alternatives are considered: one compulsory, financed through taxes, the other purchased on a voluntary basis and paid through a premium. WTP was elicited through open-ended contingent valuation within a survey conducted in the Italian region Emilia-Romagna about LTC population needs. We model information on individual WTP as a two-stage process, where respondents first establish their interest for LTC cover, then state their WTP. Results show that interest and WTP are influenced by different variables, and that differences arise also between the WTP for public and private coverage.     

Indirect taxation and the welfare effects of altruism on the optimal fiscal policy

This paper analyzes the welfare effects of altruism on the optimal fiscal policy. The existence of positive bequests links present and future generations in the economy. We show that these altruistic links provide a new role for indirect taxation (consumption and estate taxes) with important welfare implications. We use three different altruistic approaches (warm-glow, dynastic, and family) to illustrate how the presence of bequests in the budget constraint of the donee gives the government the ability to use indirect taxation to mimic lump-sum taxes and to implement the first-best outcome in the long-run. This channel is not present in economies without altruism, such as the infinite-lived consumer economy or the overlapping generations economy, where long-run welfare is suboptimal and indirect taxation is irrelevant.