Long-Term Care Insurance Purchase Patterns

Given the aging population and high cost of long-term care, many Americans are concerned about financing long-term care services. Despite this concern, private long-term care insurance policy sales have experienced slow growth. On average only about 7 percent of the population aged 65 and older has long-term care insurance, but this percentage varies greatly across the states. In this study we test hypothesized relationships between purchase of long-term care insurance and various explanatory factors. We provide evidence that state Medicaid nursing home expenditure levels and the relative sizes of the elderly population and the nursing home population are significant explanatory factors of purchase rates. We find no evidence that public–private partnership regulation, the quality of available facilities, or agent marketing controls affect purchase. Findings of the study are useful to insurers, legislators, regulators, and others involved in the public policy debate about financing long-term care.     

The Private Market for Long-Term Care Insurance in the United States: A Review of the Evidence

This article reviews the growing literature on the market for private long-term care insurance, a market notable for its small size despite the fact that long-term care expenses are potentially large and highly uncertain. After summarizing long-term care utilization and insurance coverage in the United States, the article reviews research on the supply of and the demand for private long-term care insurance. It concludes that demand-side factors impose important limits on the size of the private market and that we currently have a limited understanding of how public policies could be designed to encourage the growth of this market.     

Long-term care financing: options for the future

The aging of the baby boomers will have an enormous impact on the future of long-term care costs. This article projects the magnitude of that impact, discusses sources of financing, and considers the cost and feasibility of three options for financing future long-term care services. The authors investigate the alternatives of increasing personal savings, raising payroll taxes and expanding employer-sponsored private long-term care insurance coverage, respectively.     

Asymmetric Information, Long-Term Care Insurance, and Annuities: The Case for Bundled Contracts

This article examines the markets for long-term care insurance and annuities when there is asymmetric information and there are costs of administering contracts. Individuals differ in terms of their risk aversion. Risk-averse individuals take more care of their health and are relatively high risk in the annuities market and relatively low risk in the long-term care insurance market. In the long-term care insurance market, both separating and partial-pooling equilibria are possible. However, in the stand-alone annuity market, only separating equilibria are possible. We show, consistent with the extant empirical research, that in the presence of administration costs the more risk-averse individuals may buy relatively more long-term care insurance and more annuity coverage. Under the same assumptions, we show that equilibria exist with bundled contracts that Pareto dominate the outcomes with stand-alone contracts and are robust to competition from stand-alone contracts. The remaining empirical puzzle is to explain why bundled contracts are such a small share of the voluntary annuity market.     

乐观预期、保障能力与商业保险购买——来自中国家庭的微观证据

本文基于中国家庭微观调查数据,在考虑商业保险“保障”和“投资”双重属性的前提下,实证研究了乐观预期对家庭商业保险购买的影响。结果发现,乐观预期对家庭商业保险购买存在显著的积极影响,即户主乐观预期程度越高,家庭购买商业保险的意愿越强。进一步区分保障型商业保险和投资型商业保险,发现乐观预期对商业保险购买的积极影响主要来自对投资型商业保险的需求,对保障型商业保险购买的影响则不显著。更重要地,不同风险保障能力下乐观预期对商业保险购买存在异质性影响,家庭储蓄较多、社会保障覆盖较好以及社会资本水平较高的家庭,乐观预期对商业保险购买的积极影响更大。本研究不仅有助于从预期视角理解商业保险市场的“有限参与”之谜,也为提升家庭风险保障和财富增值能力提供了借鉴。     

美国长期护理保障制度改革及其对我国的启示

本文主要运用文献研究法,对美国长期护理保障制度的现状进行了分析。分析发现,当前关国长期护理保障制度存在两大问题,分别是政府财政转移支付缺乏可持续性、私人保单难以覆盖广大中低收入阶层。为解决上述问题,关国政府对长期护理保障制度采取了一系列改革措施,但改革始终没能达到预期效果。美国长期护理保障制度改革启示我们,长期护理保障...     

夫妻联合长期护理保险的定价模型与应用

在人口老龄化和人口长寿背景下,社会对老年长期护理保障的需求不断增长,基于家庭保障的理念,本文将多元寿险模型推广到夫妻联合长期护理保险,构建了健康、轻度失能、重度失能和死亡的马尔科夫四状态转移模型,并在联合个体状态转移相互独立的假设下给出了夫妻联合长期护理保险定价模型.最后基于中国老年健康影响因素跟踪调查微观数据,实现了...     

The Impact of Regret on the Demand for Insurance

We examine optimal insurance purchase decisions of individuals that exhibit behavior consistent with Regret Theory. Our model incorporates a utility function that assigns a disutility to outcomes that are ex post suboptimal, and predicts that individuals with regret‐theoretical preferences adjust away from the extremes of full insurance and no insurance coverage. This prediction holds for both coinsurance and deductible contracts, and can explain the frequently observed preferences for low deductibles in markets for personal insurance.     

Regret in health insurance post‐purchase behavior

Unlike other forms of insurance, individuals with health insurance generally expect to make claims through the policy period. Selecting an appropriate level of cost‐sharing is difficult and individuals may, ex‐post, regret the choice of a less‐than‐suitable coverage amount. Using a national health insurance survey of private market consumers from 2013 to 2017, we evaluate the potential for post‐purchase regret in the health plan purchasing decision. We employ an ordered logistic model and find that consumers whose plan choices were likely financially dominated by a foregone alternative are significantly more likely to express regret through reporting significantly lower likelihood of renewal, even when controlling for confounding considerations including affordability, self‐assessed risk, and satisfaction with the plan.     

Wealth, Income, and Optimal Insurance

This article considers the decision to purchase insurance against possible losses of a property or wealth. The decision involves a standard economic trade‐off between the benefit of protection against loss and the cost of insurance premium. The premium is paid out of the income and decreases the consumption of other goods and services, rather than out of wealth and decreases the property or wealth. The demand for insurance depends mainly on the income and preferences. As a result, unlike in the standard model, a fair premium is neither necessary nor sufficient for the optimality of full coverage insurance. Rather, the individuals with higher incomes purchase full coverage insurance even at unfair prices of insurance while the individuals with lower income purchase partial coverage insurance at a fair price.     

Marktversagen auf dem geförderten Pflegezusatzversicherungsmarkt?

This study analyzes the supply side of the private German long term care insurance market. It compares loads and comprehensiveness of subsidized and unsubsidized insurance policies for three age groups. The results show that subsidized insurance policies are less comprehensive than unsubsidized insurance policies. In addition the premiums of subsidized policies are marked up substantially above expected benefits compared to unsubsidized policies. All in all these results indicate market failure due to adverse selection within the subsidized private long term care insurance market. Furthermore, the results show that due to unisex pricing, private long term care policies are in general more attractive to women than to men. As this is not reflected in demand, other factors than supply side failure seem to contribute to an overall low demand for private long term care insurance policies.     

Issuance Decisions and Strategic Focus: The Case of Long-Term Care Insurance

Increasing costs of long-term care are placing ever greater burdens on state and federal budgets, yet private long-term care insurance remains a relatively minor financing vehicle. Although many researchers provide rationales for the limited private market, some life–health insurers have forged ahead into this relatively new and risky line of business. We investigate what makes these insurers different and whether managers are following a diversification or strategic focus strategy. We find that strategic focus is a consistently important factor and that managers' participation and volume decisions are made independently.     

Consumption Externality and Equilibrium Underinsurance

Relative consumption has been found to be crucial in many areas, such as asset pricing, the design of taxation, and economic growth. This article extends this line of research to the individual's insurance decision. We first define “keeping up with the Joneses” in the purchase of insurance and find that jealousy does not necessarily give rise to “keeping up with the Joneses.” We also identify several sufficient conditions that cause the optimal coverage in the private market to be less than the social optimum (equilibrium underinsurance). Jealousy is found to be neither a sufficient nor a necessary condition for equilibrium underinsurance. We further show that a social welfare maximizing government could adopt a tax system to correct for the consumption externality and make individuals better off.     

Public Versus Private Insurance with Dual Theory: A Political Economy Argument

This paper analyzes the political support for public insurance in the presence of a private insurance alternative. The public insurance is compulsory and offers a uniform insurance policy. The private insurance is voluntary and can offer different insurance policies. Adopting Yaari's [Econometrica, 55, 95–115, 1987] dual theory to expected utility (i.e., risk aversion without diminishing marginal utility of income), we show that adverse selection on the private insurance market may lead a majority of individuals to prefer public insurance over private insurance, even if the median risk is below the average risk (so that the median actually subsidizes high-risk individuals). We also show that risk aversion makes public insurance more attractive and that the dual theory is less favourable to a mixed insurance system than the expected utility framework. Lastly, we demonstrate how the use of genetic tests may threaten the political viability of public insurance.     

Financing long-term care: employee needs and attitudes, and the employer's role.

Because of increasing life expectancies, high costs for nursing home and home health care, declining levels of informal family care, and the stated policy of the federal and state governments to foster self-reliance, individuals are increasingly exposed to the risk of financial ruin from long-term care (LTC) expenses. Yet, because of psychological barriers and aversions, particularly to thinking about residing in a nursing home, most individuals have not purchased LTC insurance. Hence, it may be the responsibility of employers to provide education to employees about LTC and to sponsor either individual or group plans of LTC insurance. Educational efforts may be particularly effective at the time of retirement when employees are in a more serious mood to consider the contingencies of retired life. A formal and perhaps more economical response for employers would be to offer combined life annuity and LTC insurance benefits through the retirement plan, provided certain regulatory and tax barriers can be removed.     

Commitment problems justify subsidies for medical insurance

Consumers who believe that government will provide them with some public medical care, even if they did not purchase medical insurance, may choose to purchase no such insurance. The amount of medical care consumed will then be less than the first-best optimum. Under specified conditions government can then increase the welfare of consumers by subsidizing insurance, or by providing public health care at a more generous level than the minimum it would otherwise give.     

论发展我国非营利民营医疗保险制度

中国已经建立并正在完善多层次医疗保障体系,但同时也遇到了由于多支柱医疗保险制度之间的巨大差异所带来的困难和问题。为此,本文首先提出我国应走一条基本+补充,同时大力发展非营利民营医疗保险的中间型的发展医疗保险制度的新途径;其次探讨了英国、美国、澳大利亚和印度等国非营利民营医疗保险组织的发展经验,并总结了非营利民营医疗保险组织的一般特征;最后,文章就中国如何具体发展非营利民营医疗保险介绍了几点思路。     

Negligence,Ignorance and the Demand for Liability Insurance

This paper considers whether lack of information regarding risk exposures can lead to a demand for negligence liability insurance. We find that, under the uniform negligence rule, such as the “reasonable person” standard used to determine negligence in the U.S. and other countries, the value of information is positive and any demand for liability insurance must come from informed individuals. The necessary and sufficient condition is that good risks find it less costly to be negligent and purchase insurance.     

Managed Care and Health Care Utilization: Specification of Bivariate Models Using Copulas

This article studies the effect of managed care on health care utilization compared to traditional fee-for-service plans in private health insurance market. To construct our hypothesis, we build a game-theoretic model to study health care utilization under a two-sided moral hazard: of patients and providers. In econometric modeling, we employ a copula regression to jointly examine individuals’ health plan choice and their utilization of medical care services, because of the endogeneity of insurance choice. The dependence parameter in the copula reflects the relation between the two outcomes, based on which the average treatment effects are further derived. We apply the methodology to a survey data set of the U.S. population and consider three types of curative care and three types of preventive care for the measurement of medical care utilization. We find that managed care is in general associated with higher care utilization. Evidence is also found on the underlying incentives of both patients and medical providers.     

中国长期护理保险财政负担能力研究

本文通过测算城乡居民和城镇职工长期护理保险需求,构建医疗保险精算模型,对中国长期护理保险财政负担能力展开研究。结果发现:依托城乡居民医疗保险建立的长期护理保险会增加财政支出,但是支出规模在可控范围内;依托城镇职工医疗保险建立的长期护理保险会威胁职工医疗保险统筹基金的安全,因而不可持续,但是该问题可以通过改革职工医疗保险个人账户来解决;中国长期护理保险应该采用“个人缴费+医疗保险基金补助+财政补助”的模式,且个人缴费最高不超过15%;中国长期护理保险财政负担水平总体较低,财政有能力维持长期护理保险的运行。对此,我国应尽快正式建立全国性的长期护理保险制度和财政对长期护理保险的投入机制。