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Income and the Utilization of Long-Term Care Services: Evidence from the Social Security Benefit Notch

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  • Gopi Shah Goda
  • Ezra Golberstein
  • David C. Grabowski

Abstract

This paper estimates the impact of income on the long-term care utilization of elderly Americans using a natural experiment that led otherwise similar retirees to receive significantly different Social Security payments based on their year of birth. Using data from the 1993 and 1995 waves of the AHEAD, we estimate instrumental variables models and find that a positive permanent income shock lowers nursing home use but increases the utilization of paid home care services. We find some suggestive evidence that the effects are due to substitution of home care for nursing home utilization. The magnitude of these estimates suggests that moderate reductions in post-retirement income would significantly alter long-term utilization patterns among elderly individuals.

Suggested Citation

  • Gopi Shah Goda & Ezra Golberstein & David C. Grabowski, 2010. "Income and the Utilization of Long-Term Care Services: Evidence from the Social Security Benefit Notch," NBER Working Papers 16076, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:16076
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    References listed on IDEAS

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    Cited by:

    1. Thang Dang, 2022. "Retirement and health services utilization in a low‐income country," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 30(3), pages 597-620, July.
    2. Sicsic, Jonathan & Ravesteijn, Bastian & Rapp, Thomas, 2020. "Are frail elderly people in Europe high-need subjects? First evidence from the SPRINTT data," Health Policy, Elsevier, vol. 124(8), pages 865-872.
    3. Padmaja Ayyagari & David Frisvold, 2016. "The Impact of Social Security Income on Cognitive Function at Older Ages Full Access," American Journal of Health Economics, MIT Press, vol. 2(4), pages 463-488, Fall.
    4. David C. Grabowski & Edward C. Norton & Courtney H. Van Houtven, 2012. "Informal Care," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 30, Edward Elgar Publishing.
    5. Paula Cristina Albuquerque, 2020. "Need, unmet need, and shortage in the long-term care market," Working Papers Department of Economics 2020/01, ISEG - Lisbon School of Economics and Management, Department of Economics, Universidade de Lisboa.
    6. Tsai, Yuping, 2015. "Social security income and the utilization of home care: Evidence from the social security notch," Journal of Health Economics, Elsevier, vol. 43(C), pages 45-55.
    7. Costa-Font, Joan & Frank, Richard G. & Swartz, Katherine, 2019. "Access to long term care after a wealth shock: Evidence from the housing bubble and burst," The Journal of the Economics of Ageing, Elsevier, vol. 13(C), pages 103-110.
    8. Chen, Xi & Wang, Tianyu & Busch, Susan H., 2019. "Does money relieve depression? Evidence from social pension expansions in China," Social Science & Medicine, Elsevier, vol. 220(C), pages 411-420.
    9. Siha Lee & Kegon Teng Kok Tan, 2023. "Bequest Motives and the Social Security Notch," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 51, pages 888-914, December.
    10. van Noort, Olivier & Schotanus, Fredo & van de Klundert, Joris & Telgen, Jan, 2018. "Explaining regional variation in home care use by demand and supply variables," Health Policy, Elsevier, vol. 122(2), pages 140-146.
    11. Mommaerts, Corina, 2018. "Are coresidence and nursing homes substitutes? Evidence from Medicaid spend-down provisions," Journal of Health Economics, Elsevier, vol. 59(C), pages 125-138.
    12. Tran, My & Gannon, Brenda & Rose, Christiern, 2023. "The effect of housing wealth on older adults’ health care utilization: Evidence from fluctuations in the U.S. housing market," Journal of Health Economics, Elsevier, vol. 88(C).
    13. Padmaja Ayyagari & David Frisvold, 2015. "The Impact of Social Security Income on Cognitive Function at Older Ages," NBER Working Papers 21484, National Bureau of Economic Research, Inc.
    14. Terence C. Cheng & Joan Costa-Font & Nattavudh Powdthavee, 2018. "Do You Have to Win It to Fix It? A Longitudinal Study of Lottery Winners and Their Health-Care Demand," American Journal of Health Economics, MIT Press, vol. 4(1), pages 26-50, Winter.
    15. Yuping Tsai, 2018. "Social Security Income and Health Care Spending: Evidence from the Social Security Notch," Scandinavian Journal of Economics, Wiley Blackwell, vol. 120(2), pages 440-464, April.
    16. Norman Bannenberg & Oddvar Førland & Tor Iversen & Martin Karlsson & Henning Øien, 2021. "Preventive Home Visits," American Journal of Health Economics, University of Chicago Press, vol. 7(4), pages 457-496.
    17. Jing Dong & Daifeng He & John A. Nyman & R. Tamara Konetzka, 2021. "Wealth and the utilization of long-term care services: evidence from the United States," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 345-366, September.
    18. Owen O'Donnell & Eddy Van Doorslaer & Tom Van Ourti, 2013. "Health and Inequality," Tinbergen Institute Discussion Papers 13-170/V, Tinbergen Institute.
    19. Liu, Yinan & Zai, Xianhua, 2022. "The Unintended Effect of Medicaid Aging Waivers on Informal Caregiving," EconStor Preprints 249566, ZBW - Leibniz Information Centre for Economics.
    20. 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.
    21. Changyong Yang & Jianyuan Huang & Jiahao Yu, 2023. "Inequalities in Resource Distribution and Healthcare Service Utilization of Long-Term Care in China," IJERPH, MDPI, vol. 20(4), pages 1-17, February.
    22. Mommaerts, Corina & Truskinovsky, Yulya, 2020. "The cyclicality of informal care," Journal of Health Economics, Elsevier, vol. 71(C).
    23. Yinan Liu & Emma Zai, 2023. "The unintended effect of Medicaid aging waivers on informal caregiving," MPIDR Working Papers WP-2023-006, Max Planck Institute for Demographic Research, Rostock, Germany.
    24. Moulton, Jeremy Grant & Stevens, Ann Huff, 2015. "Reconsidering the Social Security Notch and retirement: Wealth and incentive effects," Economics Letters, Elsevier, vol. 132(C), pages 65-68.
    25. Thomas Url, 2011. "Private Versicherungen als Finanzierungsquelle für den Pflegebedarf im Alter," WIFO Studies, WIFO, number 41358, Juni.

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    More about this item

    JEL classification:

    • H55 - Public Economics - - National Government Expenditures and Related Policies - - - Social Security and Public Pensions
    • I1 - Health, Education, and Welfare - - Health
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

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