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Evaluating Long-Term-Care Policy Options, Taking the Family Seriously


  • Daniel Barczyk
  • Matthias Kredler


We propose a dynamic non-cooperative framework for long-term-care (LTC) decisions of families and use it to evaluate LTC policy options for the U.S. We first document the importance of informal caregiving and economic determinants of care arrangements. We then build a heterogeneous-agents model with imperfectly-altruistic overlapping generations to account for the patterns we find. A key innovation is the availability of informal care (IC), which is determined through intra-family bargaining. This opens up a new margin in response to policy and allows for informal insurance through home-production of care. Our calibrated model captures the observed care arrangements well. We study the implications of non-means-tested IC and formal care (FC) subsidies as well as changes to means-tested Medicaid. We find that IC responds strongly to these policies. An IC subsidy substantially reduces reliance on Medicaid, while the reduction of tax revenues due to lower labour supply by caregivers is modest. There are large welfare gains from a combination of IC and FC subsidies, even when combined with a reduction of the Medicaid program.

Suggested Citation

  • Daniel Barczyk & Matthias Kredler, 2018. "Evaluating Long-Term-Care Policy Options, Taking the Family Seriously," Review of Economic Studies, Oxford University Press, vol. 85(2), pages 766-809.
  • Handle: RePEc:oup:restud:v:85:y:2018:i:2:p:766-809.

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    Cited by:

    1. Chiara Canta & Helmuth Cremer, 2020. "Asymmetric Information, Strategic Transfers, and the Design of Long-Term Care Policies," CESifo Working Paper Series 8677, CESifo.
    2. Amengual, D.; Bueren, J.; Crego, J.A.;, 2017. "Endogenous Health Groups and Heterogeneous Dynamics of the Elderly," Health, Econometrics and Data Group (HEDG) Working Papers 17/18, HEDG, c/o Department of Economics, University of York.
    3. Daniela Del Boca & Christopher Flinn & Ewout Verriest & Matthew Wiswall, 2018. "Actors in the Child Development Process," Carlo Alberto Notebooks 575, Collegio Carlo Alberto.
    4. Corina Boar, 2020. "Dynastic Precautionary Savings," NBER Working Papers 26635, National Bureau of Economic Research, Inc.
    5. Chiara Canta & Pierre Pestieau & Emmanuel Thibault, 2016. "Long-term care and capital accumulation: the impact of the State, the market and the family," Economic Theory, Springer;Society for the Advancement of Economic Theory (SAET), vol. 61(4), pages 755-785, April.
    6. 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.
    7. Daniela Del Boca & Christopher Flinn & Ewout Verriest & Matthew Wiswall, 2018. "Actors in the Child Development Process," Carlo Alberto Notebooks 575, Collegio Carlo Alberto.
    8. Korfhage, Thorben, 2019. "Long-run consequences of informal elderly care and implications of public long-term care insurance," Ruhr Economic Papers 813, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    9. Amitabh Chandra & Courtney Coile & Corina Mommaerts, 2020. "What Can Economics Say About Alzheimer's Disease?," NBER Working Papers 27760, National Bureau of Economic Research, Inc.
    10. Tatyana Koreshkova & Minjoon Lee, 2020. "Nursing Homes in Equilibrium: Implications for Long-term Care Policies," Working Papers wp414, University of Michigan, Michigan Retirement Research Center.
    11. 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.
    12. Achou, Bertrand, 2021. "Housing liquidity and long-term care insurance demand: A quantitative evaluation," Journal of Public Economics, Elsevier, vol. 194(C).
    13. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond.
    14. R. Anton Braun & Karen A. Kopecky & Tatyana Koreshkova, 2017. "Old, Frail, and Uninsured: Accounting for Puzzles in the U.S. Long-Term Care Insurance Market," FRB Atlanta Working Paper 2017-3, Federal Reserve Bank of Atlanta.
    15. İmrohoroğlu, Ayşe & Zhao, Kai, 2018. "The chinese saving rate: Long-term care risks, family insurance, and demographics," Journal of Monetary Economics, Elsevier, vol. 96(C), pages 33-52.
    16. Daniel Barczyk & Matthias Kredler & Sean Fahle, 2019. "Save, Spend or Give? A Model of Housing, Family Insurance, and Savings in Old Age," 2019 Meeting Papers 361, Society for Economic Dynamics.
    17. Emanuele Ciani & Claudio Deiana, 2018. "No free lunch, buddy: past housing transfers and informal care later in life," Review of Economics of the Household, Springer, vol. 16(4), pages 971-1001, December.

    More about this item


    Long-term care; altruism; dynamic games;
    All these keywords.

    JEL classification:

    • E6 - Macroeconomics and Monetary Economics - - Macroeconomic Policy, Macroeconomic Aspects of Public Finance, and General Outlook
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination
    • D64 - Microeconomics - - Welfare Economics - - - Altruism; Philanthropy; Intergenerational Transfers
    • C73 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - Stochastic and Dynamic Games; Evolutionary Games


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