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Flexible insurance for long‐term care: A study of stated preferences

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  • Shang Wu
  • Hazel Bateman
  • Ralph Stevens
  • Susan Thorp

Abstract

Aging societies need efficient and flexible systems to finance care for the frail elderly. We study pre‐retirees' demand for flexible insurance that can finance informal long‐term care by paying income in poor health states instead of reimbursing formal care costs. We collect and analyze stated preferences for this long‐term care income product, and preferences for informal care. When asked to allocate wealth to a life annuity, a liquid investment and flexible long‐term care insurance, around 75% of our sample of 1008 pre‐retirees choose some long‐term care cover. Study participants treat long‐term care income insurance as a complement to informal care from their families. Females who expect to rely exclusively on extensive care from family members prefer more cover than similar males. We also find that if long‐term care income insurance were available, some healthier seniors would purchase additional longevity insurance, using liquid funds otherwise set aside to self‐insure long‐term care risk.

Suggested Citation

  • Shang Wu & Hazel Bateman & Ralph Stevens & Susan Thorp, 2022. "Flexible insurance for long‐term care: A study of stated preferences," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(3), pages 823-858, September.
    • Handle: RePEc:bla:jrinsu:v:89:y:2022:i:3:p:823-858
    DOI: 10.1111/jori.12379
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    as
    1. Tian Zhou‐Richter & Mark J. Browne & Helmut Gründl, 2010. "Don't They Care? Or, Are They Just Unaware? Risk Perception and the Demand for Long‐Term Care Insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 77(4), pages 715-747, December.
    2. Jeffrey R. Brown & Jeffrey R. Kling & Sendhil Mullainathan & Marian V. Wrobel, 2008. "Why Don’t People Insure Late-Life Consumption? A Framing Explanation of the Under-Annuitization Puzzle," American Economic Review, American Economic Association, vol. 98(2), pages 304-309, May.
    3. Beshears, John & Choi, James J. & Laibson, David & Madrian, Brigitte C. & Zeldes, Stephen P., 2014. "What makes annuitization more appealing?," Journal of Public Economics, Elsevier, vol. 116(C), pages 2-16.
    4. Thomas Dohmen & Armin Falk & David Huffman & Uwe Sunde & Jürgen Schupp & Gert G. Wagner, 2011. "Individual Risk Attitudes: Measurement, Determinants, And Behavioral Consequences," Journal of the European Economic Association, European Economic Association, vol. 9(3), pages 522-550, June.
    5. Tibor Besedes & Cary Deck & Sudipta Sarangi & Mikhael Shor, 2015. "Reducing Choice Overload without Reducing Choices," The Review of Economics and Statistics, MIT Press, vol. 97(4), pages 793-802, October.
    6. Andrew Caplin & Mi Luo & Kathleen McGarry, 2018. "Measuring And Modeling Intergenerational Links In Relation To Long‐Term Care," Economic Inquiry, Western Economic Association International, vol. 56(1), pages 100-113, January.
    7. Amy Finkelstein & Erzo F. P. Luttmer & Matthew J. Notowidigdo, 2013. "What Good Is Wealth Without Health? The Effect Of Health On The Marginal Utility Of Consumption," Journal of the European Economic Association, European Economic Association, vol. 11, pages 221-258, January.
    8. Jiahua Chen & Zehua Chen, 2008. "Extended Bayesian information criteria for model selection with large model spaces," Biometrika, Biometrika Trust, vol. 95(3), pages 759-771.
    9. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    10. Kim Peijnenburg & Theo Nijman & Bas J.M. Werker, 2017. "Health Cost Risk: A Potential Solution to the Annuity Puzzle," Economic Journal, Royal Economic Society, vol. 127(603), pages 1598-1625, August.
    11. Felix Reichling & Kent Smetters, 2015. "Optimal Annuitization with Stochastic Mortality and Correlated Medical Costs," American Economic Review, American Economic Association, vol. 105(11), pages 3273-3320, November.
    12. Nathaniel Hendren, 2013. "Private Information and Insurance Rejections," Econometrica, Econometric Society, vol. 81(5), pages 1713-1762, September.
    13. Jeffrey R. Brown & Arie Kapteyn & Erzo F. P. Luttmer & Olivia S. Mitchell & Anya Samek, 2021. "Behavioral Impediments to Valuing Annuities: Complexity and Choice Bracketing," The Review of Economics and Statistics, MIT Press, vol. 103(3), pages 533-546, July.
    14. Adriaan Kalwij & Giacomo Pasini & Mingqin Wu, 2014. "Home care for the elderly: the role of relatives, friends and neighbors," Review of Economics of the Household, Springer, vol. 12(2), pages 379-404, June.
    15. Les Mayhew & Martin Karlsson & Ben Rickayzen, 2010. "The Role of Private Finance in Paying for Long Term Care," Economic Journal, Royal Economic Society, vol. 120(548), pages 478-504, November.
    16. repec:tpr:restat:v:97:y:2015:i:5:p:793-802 is not listed on IDEAS
    17. Sloan, Frank A & Norton, Edward C, 1997. "Adverse Selection, Bequests, Crowding Out, and Private Demand for Insurance: Evidence from the Long-Term Care Insurance Market," Journal of Risk and Uncertainty, Springer, vol. 15(3), pages 201-219, December.
    18. de Meza, David & Webb, David C, 2001. "Advantageous Selection in Insurance Markets," RAND Journal of Economics, The RAND Corporation, vol. 32(2), pages 249-262, Summer.
    19. 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.
    20. Mariacristina De Nardi & Eric French & John Bailey Jones, 2016. "Medicaid Insurance in Old Age," American Economic Review, American Economic Association, vol. 106(11), pages 3480-3520, November.
    21. Ph. De Donder & P. Pestieau, 2017. "Private, Social, and Self-Insurance for Long-Term Care in the Presence of Family Help," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 19(1), pages 18-37, February.
    22. Boyer, M. Martin & Box-Couillard, Sébastien & Michaud, Pierre-Carl, 2020. "Demand for annuities: Price sensitivity, risk perceptions, and knowledge," Journal of Economic Behavior & Organization, Elsevier, vol. 180(C), pages 883-902.
    23. Thomas Davidoff & Jeffrey R. Brown & Peter A. Diamond, 2005. "Annuities and Individual Welfare," American Economic Review, American Economic Association, vol. 95(5), pages 1573-1590, December.
    24. Jason Brown & Mark Warshawsky, 2013. "The Life Care Annuity: A New Empirical Examination of an Insurance Innovation That Addresses Problems in the Markets for Life Annuities and Long-Term Care Insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 80(3), pages 677-704, September.
    25. Commission, Productivity, 2011. "Caring for older Australians," Inquiry Reports, Productivity Commission, Government of Australia, number 53.
    26. John Ameriks & Andrew Caplin & Steven Laufer & Stijn Van Nieuwerburgh, 2011. "The Joy of Giving or Assisted Living? Using Strategic Surveys to Separate Public Care Aversion from Bequest Motives," Journal of Finance, American Finance Association, vol. 66(2), pages 519-561, April.
    27. Akaichi, Faical & Costa-Font, Joan & Frank, Richard, 2020. "Uninsured by Choice? A choice experiment on long term care insurance," Journal of Economic Behavior & Organization, Elsevier, vol. 173(C), pages 422-434.
    28. R. Anton Braun & Karen A. Kopecky & Tatyana Koreshkova, 2019. "Old, Frail, and Uninsured: Accounting for Features of the U.S. Long‐Term Care Insurance Market," Econometrica, Econometric Society, vol. 87(3), pages 981-1019, May.
    29. Thomas Davidoff, 2009. "Housing, Health, and Annuities," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 76(1), pages 31-52, March.
    30. Wang, Qun & Abiiro, Gilbert Abotisem & Yang, Jin & Li, Peng & De Allegri, Manuela, 2021. "Preferences for long-term care insurance in China: Results from a discrete choice experiment," Social Science & Medicine, Elsevier, vol. 281(C).
    31. repec:oup:jeurec:v:15:y:2017:i:2:p:429-462. is not listed on IDEAS
    32. Ethan M.J. Lieber & Lee M. Lockwood, 2013. "Costs and Benefits of In-Kind Transfers: The Case of Medicaid Home Care Benefits," Working Papers wp294, University of Michigan, Michigan Retirement Research Center.
    33. Young Kyung Do & Edward C. Norton & Sally C. Stearns & Courtney Harold Van Houtven, 2015. "Informal Care and Caregiver's Health," Health Economics, John Wiley & Sons, Ltd., vol. 24(2), pages 224-237, February.
    34. Wu, Shang & Stevens, Ralph & Thorp, Susan, 2015. "Cohort and target age effects on subjective survival probabilities: Implications for models of the retirement phase," Journal of Economic Dynamics and Control, Elsevier, vol. 55(C), pages 39-56.
    35. Pang, Gaobo & Warshawsky, Mark, 2010. "Optimizing the equity-bond-annuity portfolio in retirement: The impact of uncertain health expenses," Insurance: Mathematics and Economics, Elsevier, vol. 46(1), pages 198-209, February.
    36. Jeffrey R. Brown & Amy Finkelstein, 2009. "The Private Market for Long‐Term Care Insurance in the United States: A Review of the Evidence," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 76(1), pages 5-29, March.
    37. 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.
    38. David C. Webb, 2009. "Asymmetric Information, Long‐Term Care Insurance, and Annuities: The Case for Bundled Contracts," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 76(1), pages 53-85, March.
    39. Ethan M. J. Lieber & Lee M. Lockwood, 2019. "Targeting with In-Kind Transfers: Evidence from Medicaid Home Care," American Economic Review, American Economic Association, vol. 109(4), pages 1461-1485, April.
    40. Ameriks, John & Mitchell, Olivia S. (ed.), 2008. "Recalibrating Retirement Spending and Saving," OUP Catalogue, Oxford University Press, number 9780199549108, Decembrie.
    41. Tokunaga, Mutsumi & Hashimoto, Hideki, 2017. "The socioeconomic within-gender gap in informal caregiving among middle-aged women: Evidence from a Japanese nationwide survey," Social Science & Medicine, Elsevier, vol. 173(C), pages 48-53.
    42. Hazel Bateman & Christine Eckert & Fedor Iskhakov & Jordan Louviere & Stephen Satchell & Susan Thorp, 2018. "Individual Capability and Effort in Retirement Benefit Choice," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 85(2), pages 483-512, June.
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