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Family spillovers and long-term care insurance

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  • Coe, Norma B.
  • Goda, Gopi Shah
  • Van Houtven, Courtney Harold

Abstract

We examine how long-term care insurance (LTCI) affects informal care use and expectations among the insured individuals and co-residence and labor market outcomes of their adult children. We address the endogeneity of LTCI coverage by instrumenting for LTCI with changes in state tax treatment of LTCI insurance policies. We do not find evidence of reductions in informal care use over a horizon of approximately eight years. However, we find that LTCI coverage reduces parents’ perceptions of the willingness of their children to care for them in the future and that the behavior of adult children changes, with LTCI resulting in lower likelihoods of adult children co-residing and stronger labor market attachment. These findings provide empirical support for the presence of spillovers of LTCI on the economic behaviors of family members.

Suggested Citation

  • Coe, Norma B. & Goda, Gopi Shah & Van Houtven, Courtney Harold, 2023. "Family spillovers and long-term care insurance," Journal of Health Economics, Elsevier, vol. 90(C).
    • Handle: RePEc:eee:jhecon:v:90:y:2023:i:c:s0167629623000589
    DOI: 10.1016/j.jhealeco.2023.102781
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    as
    1. David S. Lee & Justin McCrary & Marcelo J. Moreira & Jack Porter, 2022. "Valid t-Ratio Inference for IV," American Economic Review, American Economic Association, vol. 112(10), pages 3260-3290, October.
    2. Judite Gonçalves & France Weaver, 2017. "Effects of formal home care on hospitalizations and doctor visits," International Journal of Health Economics and Management, Springer, vol. 17(2), pages 203-233, June.
    3. Tennille J. Checkovich & Steven Stern, 2002. "Shared Caregiving Responsibilities of Adult Siblings with Elderly Parents," Journal of Human Resources, University of Wisconsin Press, vol. 37(3), pages 441-478.
    4. Courtemanche, Charles & He, Daifeng, 2009. "Tax incentives and the decision to purchase long-term care insurance," Journal of Public Economics, Elsevier, vol. 93(1-2), pages 296-310, February.
    5. Elenka Brenna & Cinzia Novi, 2016. "Is caring for older parents detrimental to women’s mental health? The role of the European North–South gradient," Review of Economics of the Household, Springer, vol. 14(4), pages 745-778, December.
    6. Dörte Heger, 2017. "The Mental Health of Children Providing Care to their Elderly Parent," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 1617-1629, December.
    7. Terza, Joseph V. & Basu, Anirban & Rathouz, Paul J., 2008. "Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling," Journal of Health Economics, Elsevier, vol. 27(3), pages 531-543, May.
    8. Courtney Harold Van Houtven & Norma B. Coe & R. Tamara Konetzka, 2015. "Family Structure and Long‐Term Care Insurance Purchase," Health Economics, John Wiley & Sons, Ltd., vol. 24(S1), pages 58-73, March.
    9. R. Tamara Konetzka & Daifeng He & Jing Dong & John A. Nyman, 2019. "Moral hazard and long-term care insurance," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 44(2), pages 231-251, April.
    10. Jeffrey R. Brown & Amy Finkelstein, 2008. "The Interaction of Public and Private Insurance: Medicaid and the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 98(3), pages 1083-1102, June.
    11. Anand, Priyanka & Dague, Laura & Wagner, Kathryn L., 2022. "The role of paid family leave in labor supply responses to a spouse's disability or health shock," Journal of Health Economics, Elsevier, vol. 83(C).
    12. Stock, James H & Wright, Jonathan H & Yogo, Motohiro, 2002. "A Survey of Weak Instruments and Weak Identification in Generalized Method of Moments," Journal of Business & Economic Statistics, American Statistical Association, vol. 20(4), pages 518-529, October.
    13. Bom, Judith & Bakx, Pieter & Schut, Frederik & van Doorslaer, Eddy, 2019. "Health effects of caring for and about parents and spouses," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).
    14. Hiedemann, Bridget & Stern, Steven, 1999. "Strategic play among family members when making long-term care decisions," Journal of Economic Behavior & Organization, Elsevier, vol. 40(1), pages 29-57, September.
    15. Norma B. Coe & Courtney Harold Van Houtven, 2009. "Caring for mom and neglecting yourself? The health effects of caring for an elderly parent," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 991-1010, September.
    16. Maxim Engers & Steven Stern, 2002. "Long-Term Care and Family Bargaining," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 43(1), pages 73-114, February.
    17. Charles, Kerwin Kofi & Sevak, Purvi, 2005. "Can family caregiving substitute for nursing home care?," Journal of Health Economics, Elsevier, vol. 24(6), pages 1174-1190, November.
    18. Bridget Hiedemann & Michelle Sovinsky & Steven Stern, 2018. "Will You Still Want Me Tomorrow?: The Dynamics of Families’ Long-Term Care Arrangements," Journal of Human Resources, University of Wisconsin Press, vol. 53(3), pages 663-716.
    19. Costa-Font, Joan & Jimenez-Martin, Sergi & Vilaplana, Cristina, 2018. "Does long-term care subsidization reduce hospital admissions and utilization?," Journal of Health Economics, Elsevier, vol. 58(C), pages 43-66.
    20. repec:wly:hlthec:v:26:y:2017:i::p:127-138 is not listed on IDEAS
    21. Bergquist, Savannah & Costa-Font, Joan & Swartz, Katherine, 2018. "Long-term care partnerships: Are they fit for purpose?," The Journal of the Economics of Ageing, Elsevier, vol. 12(C), pages 151-158.
    22. Bonsang, Eric, 2009. "Does informal care from children to their elderly parents substitute for formal care in Europe?," Journal of Health Economics, Elsevier, vol. 28(1), pages 143-154, January.
    23. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 249-275.
    24. van den Berg, Bernard & Fiebig, Denzil G. & Hall, Jane, 2014. "Well-being losses due to care-giving," Journal of Health Economics, Elsevier, vol. 35(C), pages 123-131.
    25. Jeffrey R. Brown & Amy Finkelstein, 2011. "Insuring Long-Term Care in the United States," Journal of Economic Perspectives, American Economic Association, vol. 25(4), pages 119-142, Fall.
    26. Jeffrey M. Wooldridge, 2015. "Control Function Methods in Applied Econometrics," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 420-445.
    27. Amy Finkelstein & Kathleen McGarry, 2006. "Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 96(4), pages 938-958, September.
    28. Fu, Rong & Noguchi, Haruko & Kawamura, Akira & Takahashi, Hideto & Tamiya, Nanako, 2017. "Spillover effect of Japanese long-term care insurance as an employment promotion policy for family caregivers," Journal of Health Economics, Elsevier, vol. 56(C), pages 103-112.
    29. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 31(3), pages 129-137.
    30. Norma B. Coe & Jing Guo & R. Tamara Konetzka & Courtney Harold Van Houtven, 2019. "What is the marginal benefit of payment‐induced family care? Impact on Medicaid spending and health of care recipients," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 678-692, May.
    31. Goda, Gopi Shah, 2011. "The impact of state tax subsidies for private long-term care insurance on coverage and Medicaid expenditures," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 744-757, August.
    32. Bauer, Jan Michael & Sousa-Poza, Alfonso, 2015. "Impacts of Informal Caregiving on Caregiver Employment, Health, and Family," IZA Discussion Papers 8851, Institute of Labor Economics (IZA).
    33. Mellor, Jennifer M., 2001. "Long-term care and nursing home coverage: are adult children substitutes for insurance policies?," Journal of Health Economics, Elsevier, vol. 20(4), pages 527-547, July.
    34. Ingo W K Kolodziej & Norma B Coe & Courtney H Van Houtven, 2022. "The Impact of Care Intensity and Work on the Mental Health of Family Caregivers: Losses and Gains [Instrumental variables and the search for identification: From supply and demand to natural experi," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 77(Supplemen), pages 98-111.
    35. Amy Finkelstein & Kathleen McGarry & Amir Sufi, 2005. "Dynamic Inefficiencies in Insurance Markets: Evidence from Long-Term Care Insurance," American Economic Review, American Economic Association, vol. 95(2), pages 224-228, May.
    36. P.L. de Zwart & P. Bakx & E.K.A. van Doorslaer, 2017. "Will you still need me, will you still feed me when I'm 64? The health impact of caregiving to one's spouse," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 127-138, September.
    37. Pauly, Mark V, 1990. "The Rational Nonpurchase of Long-term-Care Insurance," Journal of Political Economy, University of Chicago Press, vol. 98(1), pages 153-168, February.
    38. Van Houtven, Courtney Harold & Norton, Edward C., 2008. "Informal care and Medicare expenditures: Testing for heterogeneous treatment effects," Journal of Health Economics, Elsevier, vol. 27(1), pages 134-156, January.
    39. Isaiah Andrews & James H. Stock & Liyang Sun, 2019. "Weak Instruments in Instrumental Variables Regression: Theory and Practice," Annual Review of Economics, Annual Reviews, vol. 11(1), pages 727-753, August.
    40. David Byrne & Michelle S. Goeree & Bridget Hiedemann & Steven Stern, 2009. "Formal Home Health Care, Informal Care, And Family Decision Making," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 50(4), pages 1205-1242, November.
    41. Eric Stallard, 2011. "Estimates of the Incidence, Prevalence, Duration, Intensity, and Cost of Chronic Disability Among the U.S. Elderly," North American Actuarial Journal, Taylor & Francis Journals, vol. 15(1), pages 32-58.
    42. Schmitz, Hendrik & Westphal, Matthias, 2015. "Short- and medium-term effects of informal care provision on female caregivers’ health," Journal of Health Economics, Elsevier, vol. 42(C), pages 174-185.
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    More about this item

    Keywords

    Long-term care insurance; Informal care; Intra-family behavioral response; Co-residence; Work; Expectations; Family behavior;
    All these keywords.

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H31 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - Household
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H71 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Taxation, Subsidies, and Revenue
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

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