Disabled Elders' Out-of-Pocket Home Care Expenses: Examining Financial Burden

Questions regarding the extent to which home care expenses are financially burdensome for disabled elders and who is most at risk of financial burden were examined using data from the 1989 National Long-Term Care Survey. Three of the four definitions of financial burden (expenditures relative to ability to pay) suggest that fewer than 11.2 percent of home care users have burdensome costs. Potential public and/or private options for protecting consumers at risk of burdensome home care costs are discussed. Discussion of how to understand home care financial burden focuses on current expectations and policy issues regarding the use of household income, assets, and home equity to pay for long-term care.     

Presence of children and household food expenditures at home and away from home

Households with children spend more on food at home than do households without children. On the other hand, compared with households without children, households with children who are at least 12 years of age are associated with higher expenditures on food away from home expenditures. Households with employed spouses are associated with lower expenditures on food at home. Other determinants of expenditures on food at home are seasonality, house ownership, region, household size, education, age and income. House ownership, region, household size, race, education and income also affect expenditures on food away from home.     

Consumption Patterns Among the Young-Old and Old-Old

Data on 2,810 elderly households were drawn from the Bureau of Labor Statistics 1990 Consumer Expenditure Survey. Multivariate Tobit analysis was used to examine spending pattern differences between households with a reference person aged 65–74 (young-old) and households with a reference person aged 75 and older (old-old). Significant differences in spending were found for expenditures on food at home, food away from home, alcohol and tobacco, housing, apparel and apparel services, transportation, bealthcare, bentertainment, personal care, and personal insurance. The impact of socio-demographic factors on expenditures by either age group was not uniform.     

Spending patterns of lone-parent and two-parent Canadian families

Data on 214 lone-parent families and 1,133 two-parent families were drawn from the Canadian 1990 Survey of Family Expenditures to examine their expenditure patterns. Tobit analysis was used to estimate marginal propensities to consume and income elasticities of 14 expenditure categories. Statistically significant differences between lone-parent families and two-parent families were found for the marginal propensities to consume and the income elasticities for expenditures on food at home, household operations and personal care.     

Innovative healthcare delivery

Critics of the American healthcare system recite a long list of problems, including rising out-of-pocket costs, inconvenient access, overuse of emergency departments, uncoordinated medical records, and declining numbers of primary care doctors. To address these issues, some new venues have evolved, such as retail and urgent care clinics; however, the emergency department has become the only service provider available to all patients on a 24/7 basis. It is time to reinvent the system. The concept of patient-centered medical homes offers a structure for integrating innovations that can transform the delivery of healthcare. In this model, each patient develops an ongoing relationship with a primary care physician supported by a team of caregivers. An integral feature is the electronic medical record, which facilitates coordinated communication and decisions. Access expands beyond the traditional physician office visit to satellite services tailored to individual needs. Services center on whole-person care, including wellness and preventive counseling, as well as acute and chronic care. Adoption of the patient-centered medical home transforms healthcare delivery into a system that benefits everyone.     

The Influence of Children on Family Life Cycle Spending Behavior: Theory and Applications

This study examines the effect of children on family consumption decisions during different stages of the life cycle. An empirical model that incorporates both continuous measures of adult equivalence and a flexible functional form is used. Results indicate that durables, food eaten (purchased) away from home, and adult clothing are luxury goods for two-child families. Economies of scale are noted for food and shelter expenditures. Two-child families substitute out of expenditures for meals eaten away from home, adult clothing, and other goods and services to meet increased demand due to the children's presence.     

Consumer Unit Types and Expenditures on Food Away from Home

This paper explores the relationship between consumer unit type and expenditures on food away from home using microdata from the 1989 Consumer Expenditure Survey. A log-linear model is used to purge the effects of income and race/ethnicity from the consumer unit type/food-away-from-home expenditure relationship. The income-and race/ethnicity-controlled propensities to purchase food away from home among eight consumer unit types are revealed in simple percentage form. These adjusted percentages are discussed in regard to current and future business strategy designed to address industrywide declines in expenditures on food away from home. The results offer support for some existing strategies as well as provide the basis for viable alternatives. Log-linear purging is shown to be a valuable tool for consumer researchers.     

Secondary household production of food: the influence of home meal preparation on food expenditures and reported adequacy

A path model was tested to ascertain the relationships between certain socio-economic and demographic variables, the percentage of household meals prepared and eaten at home (secondary household production), food expenditures, and the household's reported adequacy of food consumed. Significant positive predictors of secondary household production of food were the age of the head and household size. Negative predictors were education of the head, income of the head(s) and number of hours worked by the household head(s). By far the most important predictor was the number of hours worked. The strongest predictor of food expenditures was household size. Other positive predictors were income of the head(s), number of household heads and the degree of urbanization. Negatively affecting food expenditures was secondary household production of food, indicating the ‘saving’ effect of preparing meals at home. The household's reported adequacy of their food was predicted by the positive effect of education of the head, age of the head, tenure, hours worked by the head(s) and number of household heads. Although the number of hours the heads are employed decreased the percentage of meals prepared at home, and the percentage of meals at home negatively affected expenditures, the number of employment hours had no effect on food expenditures.     

Family Composition,Parental Time,and Market Goods: Life Cycle Trade-Offs

The present study supplements Canadian consumer expenditure survey data with unique time use data to analyze family life cycle decisions regarding allocation of full income to market purchased consumption goods, home production, and leisure time. Results confirm that young children's presence causes families to increase their shares of full income allocated to home production and to decrease the shares of full income allocated to leisure. As a share of full income, expenditures for market goods steadily increase while expenditures for women's home production diminish as children age.     

Outsourcing child care,home cleaning and meal preparation

In this paper, the outsourcing of child care, home cleaning and meal preparation is analysed by means of a socio‐economic model that incorporates household‐economic, life cycle, lifestyle and health variables. The data (n = 700) were collected during a telephone survey in the Netherlands. About 10% of the households did not use any of the three outsourcing types. About 70 to 90% of households outsourced meal preparation at least once per month. In each household life cycle stage, the average monthly expenditures on outsourcing meal preparation were the highest of the three outsourcing categories. Factors affecting expenditures were generally the same for each type of outsourcing studied. In general, household economic variables including wage and working hours were unimportant in explaining the incidence and expenditures of outsourcing. The same holds for self‐reported health. All expenditure types were affected by life cycle variables. There was an indication that a traditional lifestyle and traditional family type affected outsourcing expenditures negatively. Education appeared as an important factor: regardless of gender, both medium‐ and higher‐educated people were more inclined to spend money on outsourcing than the lower educated. Especially, people younger than 44 years outsourced meal preparation. Outsourcing was neither restricted to nor especially practised by couples.     

Costs of unintentional injuries among children in an urban slum community in Kampala city,Uganda

Abstract

Unintentional injuries cause deaths, disabilities, productivity and financial losses and disproportionately affect children in low-income settings yet their cost remains under studied. This study determined the household out-of-pocket expenditure and missed school attendance due to unintentional childhood injuries in a Ugandan slum. We used a cross-sectional household survey design. Data were collected on occurrence and associated costs of unintentional injuries during a one-year period from July 2014 to June 2015. A total of 706 (44.7%) children who had suffered from injuries were reported in the one year period. More male children (N?=?415, 58.7%) suffered injuries than females (N?=?291, 41.2%). The average out-of-pocket expenditure on treating an injury was US $24.1 [standard deviation (SD)?=?±$62.8] and mean school days lost were 25 days (SD?=?±51.8). Road traffic injuries (RTIs) resulted in higher costs [mean difference was US $51.1 (95% CI: $11.4–$90.8)] compared to injuries that, for example, occurred at school. In a Ugandan slum community, unintentional childhood injuries resulted in high out-of-pocket expenditures and missed school attendance. The costs varied widely depending on external causes of the injury. These findings highlight the need to invest in population level injury prevention interventions to reduce injury costs by households.     

The Impact of the Rhode Island Catastrophic Health Insurance Plan

Under Rhode Island's statewide Catastrophic Health Insurance Plan (CHIP) in effect since January, 1975, and similar to the Long-Ribicoff National Health Insurance Proposal, Rhode Island pays catastrophic medical expenses over and above a “personal resource payment” (out-of-pocket expenses) that varies with income and amount and type of health insurance coverage. Those with qualified plans (plans providing more services) pay less out-of-pocket. Benefits accrue mainly to some middle income households. CHIP has increased demand for and prices for health insurance with qualifying coverage, and utilization of medical care. Similar impacts on a larger scale may be expected from any national health insurance program.     

Food expenditure patterns of working-wife families: Meals prepared away from home versus convenience foods

This paper investigates food expenditure patterns of working-wife families, focusing on the allocation of food dollars between two major time-saving options: meals prepared away from home and convenience foods. Data are drawn from the U.S. 1983 Consumer Expenditure Survey. Analysis of variance and regression techniques are used to compare expenditure patterns of families grouped by the wife's hours worked and her earnings. The findings suggest that working-wife families prefer the purchasing of meals prepared away from home to that of convenience foods. In particular, families with high-earning, full-time working wives buy the most meals prepared away from home, while the greatest expenditures on convenience foods are observed for families with moderate-earning working wives.     

Improving Incentives in Health Care Spending

Although U.S. economic growth is likely to continue to be robust, the growth of private and public spending on health care presents long-run public policy challenges. To meet these challenges health care resources must be used more efficiently. Currently, there are few incentives to put health care dollars to the highest value use. This is true in both public and private spending. An important element of the problem lies in the tax-preferred treatment given to employer-provided insurance but not to out-of-pocket spending. The resulting bias towards first-dollar insurance coverage means that consumers are insulated from the real costs of the health care that they consume and have little reason to evaluate whether the benefits are greater than those costs. Moreover, they seldom have sufficient price and quality information to make informed decisions. Health Savings Accounts (HSAs) are a promising way to remove the tax-penalty for enrolling in catastrophic insurance and paying for routine care out of pocket. Given the information that they need, consumers would then have more choices and more control, strengthening their role in reducing waste, improving efficiency, and promoting competition. Coupled with other policies, HSAs can be a critical component in moving toward an efficient and equitable health care system. JEL Classification I11     

中国社会福利体系适度性研究——国际比较与实证分析

社会福利体系是影响经济可持续发展和社会安定的重要因素。政府在社会福利体系中起主导作用,但存在福利支出的适度性问题,福利过度或不足均不利于经济社会发展。本文对中国与OECD的社会福利体系做了比较,并选取美国等OECD七国和中国1980-2007年的数据作为样本开展实证分析。研究发现:(1)结合发达国家的经验,现阶段我国的社会福利总支出、养老保险支出和健康福利支出偏低;(2)但收入维持支出(即最低生活保障支出)却超前于经济发展水平和政府财力;(3)失业福利支出是否适度,不同分析方法得出了不同结论,有待进一步分析。     

Global aging and public finance

The world is getting older, and the rate of aging, as well as the composition of aging, has important global policy implications for public finance. We’re witnessing a speeding-up of the share of elderly in developing countries. It’s important to think about fiscal stress from aging in two ways. Aging from above results in changes in social expenditures. This is going to lead to increases in health expenditures, increases in pension expenditures, and decreases in education expenditures. Aging from below leads to changes in revenues as workers decline relative to the total population. I want to “right-size” spending on health care, pensions, and welfare. Let’s talk about our public policy values and goals and figure out what we can afford, and what that means, and who needs it.     

The medical expense deduction and income levels: Progressive or regressive?

The medical expense deduction (MED) allows taxpayers to deduct from taxable income a proportion of their out-of-pocket medical insurance and health care expenses. Because the rate of subsidy is equal to the marginal tax rate previous studies have found MED to be a regressive tax mechanism biased toward benefiting higher-income taxpayers. The authors demonstrate, using GINI coefficients, that MED makes the tax structure more progressive than it would otherwise be and increases equality of after-tax incomes.     

Bending and Stretching the Health Care Cost Curve

The Patient Protection and Affordable Care Act of 2010 (PPACA) has a number of provisions that aimed at slowing the rate of growth of health care spending. This paper examines the most prominent of these provisions and finds them to be seriously flawed and unlikely to deliver savings as intended. They are either too weak or liable to compromise quality. Moreover, some of the most important drivers of health care costs, such as fee for service payments to physicians under Medicare or limitations on physician liability are not addressed adequately. Thus, it is unlikely that the PPACA in its present form will do much to reduce the growth rate of health care expenditures.     

Analysis of tenure choice and housing expenditure patterns

This study employs a selectivity model to account for the simultaneity existing between determinations of tenure status and level of spending. Important socio-economic characteristics affecting housing tenure were identified. Results indicate that income had a more important effect on the housing expenditures of renters than owners at a lower household income level. The race of the household head had a significant effect on variations in housing expenditures for owners but not for renters, suggesting that race may be a more important factor in owner-occupant than in renter-occupant housing. While household size may be an important factor in a family's decision-making in terms of buying a home, it is suggested that once tenure status is selected family size had no significant impacts on housing expenditures. Similarly, married couples were most likely to own their own homes than were other household types; however, married households did not spend more or less than other types of households on either owned or rented accommodation. Furthermore, the analysis suggests that in assessing empirical results, attention should be given to meaningful interpretation of estimated selectivity effects as well as to testing for occurrence of selectivity bias.