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Health Expenditures and Precautionary Savings


  • Laurence J. Kotlikoff


The precautionary motive for saving is an important issue that is receiving increasing attention. Part of the motivation for this interest stems from the post war coincidence of two trends, one a decline in the U.S. rate of saving and the other an increase in insurance of various types, including unemployment insurance, annuity insurance, disability insurance, and health insurance. This paper examines precautionary saving for uncertain health care payments using a simple two period and illustrates this model's theoretical insights through simulations of a 55 period life cycle model. While derived from a highly stylized model, the simulations give the impression that precautionary saving for uncertain health expenditures could explain a large amount of aggregate savings. Adding uncertain health expenditures to the model's economy raises long run savings by almost one third, assuming individuals self insure. Arrangements for insuring uncertain health expenditures also have potentially quite sizable effects on savings. Introducing actuarially fair insurance to the economy with uncertain health expenditures reduces the steady state level of wealth of that economy by 12 percent. Switching from the fair insurance arrangement to a Medicaid-type program with an asset test further reduces steady state wealth by 75 percent.

Suggested Citation

  • Laurence J. Kotlikoff, 1986. "Health Expenditures and Precautionary Savings," NBER Working Papers 2008, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:2008
    Note: PE AG

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    References listed on IDEAS

    1. Feldstein, Martin & Horioka, Charles, 1980. "Domestic Saving and International Capital Flows," Economic Journal, Royal Economic Society, vol. 90(358), pages 314-329, June.
    2. Obstfeld, Maurice, 1986. "Capital mobility in the world economy: Theory and measurement," Carnegie-Rochester Conference Series on Public Policy, Elsevier, vol. 24(1), pages 55-103, January.
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    Cited by:

    1. Jonathan Gruber & Aaron Yelowitz, 1999. "Public Health Insurance and Private Savings," Journal of Political Economy, University of Chicago Press, vol. 107(6), pages 1249-1274, December.
    2. Marco Angrisani & Vincenzo Atella & Marianna Brunetti, 2016. "Public Health Insurance and Household Portfolio Choices: Unraveling Financial “Side Effects” of Medicare," CEIS Research Paper 382, Tor Vergata University, CEIS, revised 07 Feb 2017.
    3. Jonathan Gruber, 2003. "Medicaid," NBER Chapters,in: Means-Tested Transfer Programs in the United States, pages 15-78 National Bureau of Economic Research, Inc.
    4. Shin-Yi Chou & Jin-Tan Liu & James Hammitt, 2006. "Households’ precautionary behaviors—the effects of the introduction of National Health Insurance in Taiwan," Review of Economics of the Household, Springer, vol. 4(4), pages 395-421, December.
    5. Dana Goldman & Nicole Maestas, 2013. "Medical Expenditure Risk And Household Portfolio Choice," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 28(4), pages 527-550, June.
    6. Tullio Jappelli & Luigi Pistaferri & Guglielmo Weber, 2007. "Health care quality, economic inequality, and precautionary saving," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 327-346.
    7. Osea Giuntella, 2012. "Do immigrants squeeze natives out of bad schedules? Evidence from Italy," IZA Journal of Migration, Springer;Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), vol. 1(1), pages 1-21, December.
    8. Strulik, Holger, 2014. "A mass phenomenon: The social evolution of obesity," Journal of Health Economics, Elsevier, vol. 33(C), pages 113-125.
    9. Taiyo Fukai & Hidehiko Ichimura & Kyogo Kanazawa, 2018. "Quantifying Health Shocks Over the Life Cycle," Papers 1801.08746,
    10. Guariglia, Alessandra & Rossi, Mariacristina, 2004. "Private medical insurance and saving: evidence from the British Household Panel Survey," Journal of Health Economics, Elsevier, vol. 23(4), pages 761-783, July.
    11. Huang, Xianguo & Yoshino, Naoyuki, 2015. "Impacts of Universal Health Coverage: A Micro-founded Macroeconomic Perspective," ADBI Working Papers 533, Asian Development Bank Institute.
    12. Al Mamun, Md. & Sohag, Kazi & Hannan Mia, Md. Abdul & Salah Uddin, Gazi & Ozturk, Ilhan, 2014. "Regional differences in the dynamic linkage between CO2 emissions, sectoral output and economic growth," Renewable and Sustainable Energy Reviews, Elsevier, vol. 38(C), pages 1-11.
    13. Levin, Laurence, 1995. "Demand for health insurance and precautionary motives for savings among the elderly," Journal of Public Economics, Elsevier, vol. 57(3), pages 337-367, July.
    14. Tullio Jappelli & Luigi Pistaferri & Guglielmo Weber, 2004. "Health Care Quality and Economic Inequality," CSEF Working Papers 120, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    15. O'Donnell, Owen, 1995. "Labour supply and saving decisions with uncertainty over sickness," Journal of Health Economics, Elsevier, vol. 14(4), pages 491-504, October.
    16. Shin-Yi Chou & Jin-Tan Liu & James K. Hammitt, 2002. "Health Insurance and Households' Precautionary Behaviors - An Unusual Natural Experiment," NBER Working Papers 9394, National Bureau of Economic Research, Inc.
    17. Normann, Marcel & Langer, Thomas, 2001. "Altersvorsorge, Konsumwunsch und mangelnde Selbstdisziplin: Zur Relevanz deskriptiver Theorien für die Gestaltung von Altersvorsorgeprodukten," Sonderforschungsbereich 504 Publications 01-40, Sonderforschungsbereich 504, Universität Mannheim;Sonderforschungsbereich 504, University of Mannheim.
    18. Jeske, Karsten & Kitao, Sagiri, 2009. "U.S. tax policy and health insurance demand: Can a regressive policy improve welfare?," Journal of Monetary Economics, Elsevier, vol. 56(2), pages 210-221, March.
    19. Emla Fitzsimons & Marcos Vera-Hernandez, 2009. "A Practicioner's Guide to Evaluating the Impacts of Labor Market Programs," World Bank Other Operational Studies 11713, The World Bank.

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