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Policy Options for Long-Term Care

In: Studies in the Economics of Aging

Author

Listed:
  • David M. Cutler
  • Louise Sheiner

Abstract

This paper examines the effect of government nursing home policies on institutionalization rates and support for the elderly in the community. We combine data from the National Long Term Care Survey with information on state policies to estimate these effects. We examine two state policies for nursing home care: the ability of some high income elderly to receive Medicaid support, and the price differential between Medicaid and the private market. Both policies strongly affect aggregate nursing home utilization. as well as the composition of nursing home residents. In states with more liberal Medicaid rules. the high income elderly are more likely to use a nursing home. while in states with larger underpayments. the poor suffer reduced access. The marginal source of community care for the institutionalized elderly appears to be support from children or other helpers, rather than living alone. Almost all of the elderly in nursing homes would have lived with children or others had they been in the community. In addition, as the ease of acquiring Medicaid increases or Medicaid payments become more generous, fewer elderly receive substantial day-to-day help from their children.
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Suggested Citation

  • David M. Cutler & Louise Sheiner, 1994. "Policy Options for Long-Term Care," NBER Chapters,in: Studies in the Economics of Aging, pages 395-442 National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberch:7352
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    References listed on IDEAS

    as
    1. Ettner, Susan L., 1993. "Do elderly Medicaid patients experience reduced access to nursing home care?," Journal of Health Economics, Elsevier, vol. 12(3), pages 259-280, October.
    2. Hubbard, R Glenn & Skinner, Jonathan & Zeldes, Stephen P, 1995. "Precautionary Saving and Social Insurance," Journal of Political Economy, University of Chicago Press, vol. 103(2), pages 360-399, April.
    3. David M. Cutler, 1993. "Why Doesn't the Market Fully Insure Long-Term Care?," NBER Working Papers 4301, National Bureau of Economic Research, Inc.
    4. Feldstein, Martin, 1987. "Should Social Security Benefits Be Means Tested?," Scholarly Articles 2770498, Harvard University Department of Economics.
    5. Bernheim, B Douglas & Shleifer, Andrei & Summers, Lawrence H, 1986. "The Strategic Bequest Motive," Journal of Labor Economics, University of Chicago Press, vol. 4(3), pages 151-182, July.
    6. repec:hoo:wpaper:e-89-1 is not listed on IDEAS
    7. Alan M. Garber & Thomas E. MaCurdy, 1989. "Predicting Nursing Home Utilization Among the High-Risk Elderly," NBER Working Papers 2843, National Bureau of Economic Research, Inc.
    8. 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.
    9. Christopher D. Carroll & Lawrence H. Summers, 1991. "Consumption Growth Parallels Income Growth: Some New Evidence," NBER Chapters,in: National Saving and Economic Performance, pages 305-348 National Bureau of Economic Research, Inc.
    10. Diamond, P. A., 1977. "A framework for social security analysis," Journal of Public Economics, Elsevier, vol. 8(3), pages 275-298, December.
    11. Jane Sneddon Little, 1992. "Lessons from variations in state Medicaid expenditures," New England Economic Review, Federal Reserve Bank of Boston, issue Jan, pages 43-66.
    12. Feldstein, Martin S, 1987. "Should Social Security Benefits Be Means Tested?," Journal of Political Economy, University of Chicago Press, vol. 95(3), pages 468-484, June.
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    Cited by:

    1. Jonathan Gruber, 2003. "Medicaid," NBER Chapters,in: Means-Tested Transfer Programs in the United States, pages 15-78 National Bureau of Economic Research, Inc.
    2. Hiedemann, Bridget & Stern, Steven, 1999. "Strategic play among family members when making long-term care decisions," Journal of Economic Behavior & Organization, Elsevier, vol. 40(1), pages 29-57, September.
    3. Pascale Breuil-Genier, 1998. "Aides aux personnes agées dépendantes : la famille intervient plus que les professionnels," Économie et Statistique, Programme National Persée, vol. 316(1), pages 21-43.
    4. Sarma, Sisira & Hawley, Gordon & Basu, Kisalaya, 2009. "Transitions in living arrangements of Canadian seniors: Findings from the NPHS longitudinal data," Social Science & Medicine, Elsevier, vol. 68(6), pages 1106-1113, March.
    5. James M. Poterba, 1996. "Government Intervention in the Markets for Education and Health Care: How and Why?," NBER Chapters,in: Individual and Social Responsibility: Child Care, Education, Medical Care, and Long-Term Care in America, pages 277-308 National Bureau of Economic Research, Inc.
    6. Stabile, Mark & Laporte, Audrey & Coyte, Peter C., 2006. "Household responses to public home care programs," Journal of Health Economics, Elsevier, vol. 25(4), pages 674-701, July.
    7. repec:eee:jhecon:v:59:y:2018:i:c:p:125-138 is not listed on IDEAS
    8. Joan Costa Font & Juan Rovira Forns, 2004. "Willigness to Pay for Long-Term Care Coverage: the Role of Private Information and Self-Insurance," Working Papers in Economics 124, Universitat de Barcelona. Espai de Recerca en Economia.
    9. David M. Cutler, 1993. "Why Doesn't the Market Fully Insure Long-Term Care?," NBER Working Papers 4301, National Bureau of Economic Research, Inc.
    10. Darius Lakdawalla & Tomas Philipson, 1999. "Aging and the Growth of Long-Term Care," Working Papers 9909, Harris School of Public Policy Studies, University of Chicago.
    11. David C. Grabowski & Jonathan Gruber, 2005. "Moral Hazard in Nursing Home Use," NBER Working Papers 11723, National Bureau of Economic Research, Inc.
    12. Charles, Kerwin Kofi & Sevak, Purvi, 2005. "Can family caregiving substitute for nursing home care?," Journal of Health Economics, Elsevier, vol. 24(6), pages 1174-1190, November.
    13. Walter M. Cadette, 2000. "Financing Long-Term Care: Options for Policy," Macroeconomics 0004030, EconWPA.
    14. Orsini, Chiara, 2010. "Changing the way the elderly live: Evidence from the home health care market in the United States," Journal of Public Economics, Elsevier, vol. 94(1-2), pages 142-152, February.
    15. William F. Bassett, 2004. "Medicaid's nursing home coverage and asset transfers," Finance and Economics Discussion Series 2004-15, Board of Governors of the Federal Reserve System (U.S.).
    16. Pascale Genier, 1996. "La gestion du risque dépendance : le rôle de la famille, de l'État et du secteur privé," Économie et Statistique, Programme National Persée, vol. 291(1), pages 103-117.
    17. Agnès Gramain, 1997. "Décisions de recours au système de soins dans la prise en charge des personnes âgées dépen­ dantes : un modèle de choix discret dynamique," Économie et Prévision, Programme National Persée, vol. 129(3), pages 239-254.
    18. Hirth, Richard A., 1999. "Consumer information and competition between nonprofit and for-profit nursing homes," Journal of Health Economics, Elsevier, vol. 18(2), pages 219-240, April.
    19. Sarma, Sisira & Simpson, Wayne, 2007. "A panel multinomial logit analysis of elderly living arrangements: Evidence from aging in Manitoba longitudinal data, Canada," Social Science & Medicine, Elsevier, vol. 65(12), pages 2539-2552, December.
    20. Grabowski, David C. & Gruber, Jonathan, 2007. "Moral hazard in nursing home use," Journal of Health Economics, Elsevier, vol. 26(3), pages 560-577, May.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • H20 - Public Economics - - Taxation, Subsidies, and Revenue - - - General

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