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Why Doesn't the Market Fully Insure Long-Term Care?

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Author Info
David M. Cutler

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Abstract

This paper examines the failure of the private market to fully insure long-term care. I argue that the failure is a result of large intertemporal variability in the cost of long-term care. Unlike variability in cross section use, variability in the cost of care affects everyone in a pool and therefore cannot be diversified within a cohort. Further, since costs are serially correlated, the cost risk cannot be diversified across cohorts. Estimates suggest that the standard deviation of cost uncertainty is on the order of 4 to 14 percent for an average long-term care policy. In response to this cost risk, most long-term care policies do not insure real benefits. Policies generally pay a fixed nominal amount for care, which is updated using predetermined nominal rules. Many policies also have lifetime maximum payments and other restrictions on aggregate risk bearing by the insurer. The lack of complete long-term care insurance may be one explanation for the low rate of purchase of long-term care policies.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 4301.

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Date of creation: Mar 1993
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Handle: RePEc:nbr:nberwo:4301

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I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Dickey, David A & Fuller, Wayne A, 1981. "Likelihood Ratio Statistics for Autoregressive Time Series with a Unit Root," Econometrica, Econometric Society, vol. 49(4), pages 1057-72, June. [Downloadable!] (restricted)
  2. Alan M. Garber & Thomas E. MaCurdy, 1991. "Nursing Home Discharges and Exhaustion of Medicare Benefits," NBER Working Papers 3639, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  3. Benjamin M. Friedman & Mark Warshawsky, 1988. "Annuity Prices and Saving Behavior in the United States," NBER Chapters, in: Pensions in the U.S. Economy, pages 53-84 National Bureau of Economic Research, Inc. [Downloadable!]
  4. Zeckhauser, Richard, 1970. "Medical insurance: A case study of the tradeoff between risk spreading and appropriate incentives," Journal of Economic Theory, Elsevier, vol. 2(1), pages 10-26, March. [Downloadable!] (restricted)
  5. Andrew Dick & Alan M. Garber & Thomas MaCurdy, 1992. "Forecasting Nursing Home Utilization of Elderly Americans," NBER Working Papers 4107, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  6. Benjamin M. Friedman & Mark Warshawsky, 1988. "Annuity Prices and Saving Behavior in the United States," NBER Working Papers 1683, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  7. David M. Cutler & Louise M. Sheiner, 1993. "Policy Options for Long-Term Care," NBER Working Papers 4302, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  1. Igal Hendel & Alessandro Lizzeri, 2000. "The Role of Commitment in Dynamic Contracts: Evidence from Life Insurance," NBER Working Papers 7470, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
    Other versions:
  2. Rinaldo Brau & Matteo Lippi Bruni, 2008. "Eliciting the demand for long-term care coverage: a discrete choice modelling analysis," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 411-433. [Downloadable!]
    Other versions:
  3. Walter M. Cadette, 2000. "Financing Long-Term Care: Options for Policy," Macroeconomics 0004030, EconWPA. [Downloadable!]
  4. David M. Cutler & Louise M. Sheiner, 1993. "Policy Options for Long-Term Care," NBER Working Papers 4302, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
    Other versions:
  5. Walter M. Cadette, 1999. "Financing Long-Term Care: Options for Policy," Economics Working Paper Archive 283, Levy Economics Institute, The. [Downloadable!]
  6. Rinaldo Brau & M. Lippi Bruni & Anna Maria Pinna, 2004. "Public vs private demand for covering long term care expenditures," Working Paper CRENoS 200408, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia. [Downloadable!]
  7. Yasushi Iwamoto & Miki Kohara & Makoto Saito, 2006. "On the Consumption Insurance Effects of Long-term Care Insurance In Japan: Evidence from Micro Household Data," CIRJE F-Series CIRJE-F-443, CIRJE, Faculty of Economics, University of Tokyo. [Downloadable!]
  8. David Cutler, 1994. "Market Failure in Small Group Health Insurance," NBER Working Papers 4879, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  9. Walter M. Cadette, . "Financing Long-Term Care, Replacing a Welfare Model with an Insurance Model," Economics Public Policy Brief Archive 59, Levy Economics Institute, The. [Downloadable!]
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