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Explaining the long-term care insurance puzzle: The role of preferences for correlation and for quality of life over wealth

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  • Crainich, David
  • Goldzahl, Léontine
  • Jusot, Florence
  • Mignon, Doriane

Abstract

The paper investigates the role of two demand-side determinants of long-term care insurance: correlation preference and relative preference for quality of life over wealth. We model the effect of those preferences on the joint decision to buy long-term care and long-term care insurance contract. We test the model using data from a laboratory experiment in France. While the experimental results offer only partial support for the theoretical predictions—specifically, correlation aversion does not account for over-insurance, our analysis provides evidence that correlation seeking and the relative preference for quality of life over wealth explain the limited uptake of long-term care insurance.

Suggested Citation

  • Crainich, David & Goldzahl, Léontine & Jusot, Florence & Mignon, Doriane, 2025. "Explaining the long-term care insurance puzzle: The role of preferences for correlation and for quality of life over wealth," Journal of Health Economics, Elsevier, vol. 103(C).
    • Handle: RePEc:eee:jhecon:v:103:y:2025:i:c:s0167629625000657
    DOI: 10.1016/j.jhealeco.2025.103030
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    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. Martin Boyer & Philippe De Donder & Claude Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2017. "Long-Term Care Insurance: Knowledge Barriers, Risk Perception and Adverse Selection," NBER Working Papers 23918, National Bureau of Economic Research, Inc.
    3. Julien Forder & Florin Vadean & Stacey Rand & Juliette Malley, 2018. "The impact of long‐term care on quality of life," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 43-58, March.
    4. MOSSIN, Jan, 1968. "Aspects of rational insurance purchasing," LIDAM Reprints CORE 23, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    5. Joan Costa‐Font & Christophe Courbage, 2015. "Crowding Out of Long‐Term Care Insurance: Evidence from European Expectations Data," Health Economics, John Wiley & Sons, Ltd., vol. 24(S1), pages 74-88, March.
    6. 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.
    7. Sloan, Frank A. & Kip Viscusi, W. & Chesson, Harrell W. & Conover, Christopher J. & Whetten-Goldstein, Kathryn, 1998. "Alternative approaches to valuing intangible health losses: the evidence for multiple sclerosis1," Journal of Health Economics, Elsevier, vol. 17(4), pages 475-497, August.
    8. Mimra, Wanda & Nemitz, Janina & Waibel, Christian, 2020. "Voluntary pooling of genetic risk: A health insurance experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 180(C), pages 864-882.
    9. Corina Mommaerts, 2025. "Long-Term Care Insurance and the Family," Journal of Political Economy, University of Chicago Press, vol. 133(1), pages 1-52.
    10. Evans, William N & Viscusi, W Kip, 1991. "Estimation of State-Dependent Utility Functions Using Survey Data," The Review of Economics and Statistics, MIT Press, vol. 73(1), pages 94-104, February.
    11. Marc Fleurbaey & Stéphane Luchini & Christophe Muller & Erik Schokkaert, 2013. "Equivalent Income And Fair Evaluation Of Health Care," Health Economics, John Wiley & Sons, Ltd., vol. 22(6), pages 711-729, June.
    12. 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.
    13. Nicolas Jacquemet & Stéphane Luchini & Julie Rosaz & Jason F. Shogren, 2019. "Truth Telling Under Oath," Management Science, INFORMS, vol. 65(1), pages 426-438, January.
    14. Arthur E. Attema & Jona J. Frasch & Olivier L’Haridon, 2022. "Multivariate risk preferences in the quality‐adjusted life year model," Health Economics, John Wiley & Sons, Ltd., vol. 31(2), pages 382-398, February.
    15. Nicolas Jacquemet & Alexander G James & Stéphane Luchini & James J Murphy & Jason F Shogren, 2021. "Do truth-telling oaths improve honesty in crowd-working?," PLOS ONE, Public Library of Science, vol. 16(1), pages 1-18, January.
    16. W. Kip Viscusi, 2019. "Utility functions for mild and severe health risks," Journal of Risk and Uncertainty, Springer, vol. 58(2), pages 143-166, June.
    17. 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).
    18. Béatrice Rey, 2003. "A Note on Optimal Insurance in the presence of a Nonpecuniary Background Risk," Theory and Decision, Springer, vol. 54(1), pages 73-83, February.
    19. Barnay, Thomas & Juin, Sandrine, 2016. "Does home care for dependent elderly people improve their mental health?," Journal of Health Economics, Elsevier, vol. 45(C), pages 149-160.
    20. Attema, Arthur E. & l’Haridon, Olivier & van de Kuilen, Gijs, 2019. "Measuring multivariate risk preferences in the health domain," Journal of Health Economics, Elsevier, vol. 64(C), pages 15-24.
    21. Louis Eeckhoudt & Béatrice Rey & Harris Schlesinger, 2007. "A Good Sign for Multivariate Risk Taking," Management Science, INFORMS, vol. 53(1), pages 117-124, January.
    22. Philip J. Cook & Daniel A. Graham, 1977. "The Demand for Insurance and Protection: The Case of Irreplaceable Commodities," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 91(1), pages 143-156.
    23. Nicolas Jacquemet & Stéphane Luchini & Julie Rosaz & Jason Shogren, 2015. "Truth-telling under Oath," Post-Print halshs-01224135, HAL.
    24. Béatrice Rey, 2003. "A Note on Optimal Insurance in the presence of a Nonpecuniary Background Risk," Post-Print halshs-03352991, HAL.
    25. John Ameriks & Joseph Briggs & Andrew Caplin & Matthew D. Shapiro & Christopher Tonetti, 2020. "Long-Term-Care Utility and Late-in-Life Saving," Journal of Political Economy, University of Chicago Press, vol. 128(6), pages 2375-2451.
    26. Lillard, Lee A & Weiss, Yoram, 1997. "Uncertain Health and Survival: Effects on End-of-Life Consumption," Journal of Business & Economic Statistics, American Statistical Association, vol. 15(2), pages 254-268, April.
    27. Viscusi, W Kip & Evans, William N, 1990. "Utility Functions That Depend on Health Status: Estimates and Economic Implications," American Economic Review, American Economic Association, vol. 80(3), pages 353-374, June.
    28. Costa-Font, Joan & Rovira-Forns, Joan, 2008. "Who is willing to pay for long-term care insurance in Catalonia?," Health Policy, Elsevier, vol. 86(1), pages 72-84, April.
    29. Ralph S.J. Koijen & Stijn Nieuwerburgh & Motohiro Yogo, 2016. "Health and Mortality Delta: Assessing the Welfare Cost of Household Insurance Choice," Journal of Finance, American Finance Association, vol. 71(2), pages 957-1010, April.
    30. Jeffrey R. Brown & Amy Finkelstein, 2007. "Why Is the Market or Long-term Care Insurance So Small?," NBER Chapters, in: Public Policy and Retirement, Trans-Atlantic Public Economics Seminar (TAPES), pages 1967-1991, National Bureau of Economic Research, Inc.
    31. Crainich, David & Eeckhoudt, Louis & Courtois, Olivier Le, 2020. "Intensity of preferences for bivariate risk apportionment," Journal of Mathematical Economics, Elsevier, vol. 88(C), pages 153-160.
    32. Lambregts, Timo R. & Schut, Frederik T., 2020. "Displaced, disliked and misunderstood: A systematic review of the reasons for low uptake of long-term care insurance and life annuities," The Journal of the Economics of Ageing, Elsevier, vol. 17(C).
    33. Scott F. Richard, 1975. "Multivariate Risk Aversion, Utility Independence and Separable Utility Functions," Management Science, INFORMS, vol. 22(1), pages 12-21, September.
    34. Pierre Pestieau & Gregory Ponthière, 2012. "Long-Term Care Insurance Puzzle," Palgrave Macmillan Books, in: Joan Costa-Font & Christophe Courbage (ed.), Financing Long-Term Care in Europe, chapter 3, pages 41-52, Palgrave Macmillan.
    35. Kairies-Schwarz, Nadja & Kokot, Johanna & Vomhof, Markus & Weßling, Jens, 2017. "Health insurance choice and risk preferences under cumulative prospect theory – an experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 137(C), pages 374-397.
    36. Joan Costa‐Font & Christophe Courbage, 2015. "Crowding Out of Long‐Term Care Insurance: Evidence from European Expectations Data," Health Economics, John Wiley & Sons, Ltd., vol. 24(S1), pages 74-88, March.
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    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • C91 - Mathematical and Quantitative Methods - - Design of Experiments - - - Laboratory, Individual Behavior
    • D90 - Microeconomics - - Micro-Based Behavioral Economics - - - General

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