Showing papers on "Long-term care insurance published in 2008"
TL;DR: Brown and Finkelstein this paper show that the provision of even very incomplete public insurance can crowd out more comprehensive private policies by imposing a large implicit tax on private insurance benefits, thus potentially increasing overall risk exposure for individuals.
Abstract: A long tradition in public finance examines how public programs can crowd out private activ? ity in areas as diverse as education, savings, and insurance, among others. These studies typi? cally focus on aggregate economic implications, particularly for government expenditures and national savings. In this paper, we demonstrate that crowd-out can also have an important effect on individual welfare. Specifically, we show that the provision of even very incomplete public insurance can crowd out more comprehensive private policies by imposing a large implicit tax on private insurance benefits, thus potentially increasing overall risk exposure for individuals. We examine the interaction of public and private insurance for one of the largest uninsured financial risks facing the elderly in the United States: long-term care expenditures. At $135 bil? lion in 2004, long-term care expenditures represented over 8.5 percent of total health expendi? tures/or all ages, or roughly 1.2 percent of GDP. Moreover, real long-term care expenditures are projected to triple over the next 35 years due to rising medical costs and the aging of the baby boomers. Only 10 percent of the elderly, however, have any private long-term care insurance, and one-third of expenditures are paid for out of pocket (Congressional Budget Office (CBO) 1999; CBO 2004; Brown and Finkelstein 2007). One potential explanation for the small size of the private market is that the public insurance provided by Medicaid may crowd out demand for private insurance. Medicaid was designed to provide long-term care insurance for the poor elderly. Mark V. Pauly (1989,1990) has established the qualitative result that, as an incomplete but publicly funded source of long-term care insur? ance, Medicaid has the potential to reduce substantially demand for private long-term care insur? ance, even among the nonpoor. Our work builds on this insight by quantifying the magnitude of Medicaid's crowd-out effect and the incomplete nature of Medicaid coverage. We also illustrate the mechanism behind Medicaid's crowd-out effect, and are, therefore, able to assess the likely impact of alternative policies on private insurance demand. We develop a utility-based model of a 65-year-old risk-averse individual who chooses an opti? mal intertemporal consumption path in the presence of uncertainty about long-term care expen? ditures. We calibrate the model using data on the distribution of long-term care expenditure risk, common state Medicaid rules, and the prices and coverage of typical private long-term care insurance policies.
300 citations
TL;DR: It is found that the effects of children's presence vary substantially with gender, marital status, and opportunity costs of children, and the opportunity costs make a difference in the use of formal long-term care.
82 citations
TL;DR: It is shown that LTC insurance is purchased not only to preserve bequests and to financially protect families in the event of disability, but also to reduce the burden on potential informal care givers.
Abstract: While many theoretical arguments have been proposed to explain the decision whether to purchase long-term care (LTC) insurance, little work has been done to study this phenomenon empirically. This article uses cross-sectional data from the newly developed SHARE (Survey of Health, Ageing, and Retirement in Europe) database to estimate the determinants of the probability of purchasing LTC insurance in France. We show that LTC insurance is purchased not only to preserve bequests and to financially protect families in the event of disability, but also to reduce the burden on potential informal care givers. Risk behaviours as well as experience of disability also play a significant role in explaining the demand for LTC insurance in France.
80 citations
TL;DR: In this paper, the existence of an insurance market for long-term care is discussed and three major risks for insurers that provide longterm care insurance are identified: risk of escalating costs, risk of adverse selection and risk of moral hazard.
Abstract: This paper focuses on the existence of an insurance market for long-term care. There are three major risks for insurers that provide long-term care insurance: risk of escalating costs, risk of adverse selection and risk of moral hazard. Despite these risks, the long-term care insurance is a potentially expanding market for insurance companies able to innovate and design products tailored to this very specific demand.
75 citations
TL;DR: It is suggested that only one-fifth of the population is willing to pay for LTC coverage though it is a highly elastic product, driven by individual's perceptions of old age disability risk and housing tenure, which reduces the probability of insurance coverage demand.
36 citations
TL;DR: Prevalent stroke and, more strongly, dementia were associated with increased family caregiver burden in Japanese general populations and among patients with dementia, the presence of stroke did not enhance caregiverurden further.
Abstract: Background: Limited data are available on caregiver burden for stroke and dementia patients. We examined the associations of prevalent stroke and dementia with family caregiver burd
35 citations
TL;DR: Multivariate analysis revealed that the degree of support/care required, gender and living condition were found to serve as variables that significantly contribute to utility in the recently introduced LTCI system.
32 citations
TL;DR: Households exposed to large increases in home equity in the recent housing boom were relatively unlikely to add LTCI coverage and relatively likely to drop coverage.
Abstract: Long term care is one of the few observable triggers for home sale among the elderly. Combined with a thin reverse mortgage market, this helps rationalize weak demand for Long Term Care Insurance (LTCI). Home equity typically tapped primarily in the event of long term care reduces the gain to insurance transfers from healthy states. Households exposed to large increases in home equity in the recent housing boom were relatively unlikely to add LTCI coverage and relatively likely to drop coverage.
17 citations
TL;DR: It is found that publicly provided health-based LTC crowds out the medical spending among low health individuals, and means-tested programs lead to higher initial spending on medical care and consumption goods among middle-wealth individuals.
15 citations
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TL;DR: In this article, the rationale of long-term care insurance purchasing is analyzed from a statistical analysis of insurance data and a life cycle model, and the authors make a short survey of the pros and cons of LTC insurance purchase.
Abstract: This paper analyzes the rationale of long-term care insurance purchasing, from a statistical analysis of insurance data and a life cycle model We make a short survey of the pros and cons of LTC insurance purchase Then risk distributions in the occurrence and duration dimension are estimated on a Spanish portfolio Calendar effects are estimated besides age and gender These statistical results are integrated in a life cycle model of savings and insurance purchasing A numerical illustration is also provided, which leads to an optimal age of forty years for insurance purchase
13 citations
TL;DR: It is shown that the use of LTC in Japan – particularly home care – is growing rapidly, as the elderly consumers find subsidized LTC care preferable to and more available than hospitalization.
Abstract: The recently enacted Japanese long-term care (LTC) system was implemented to reduce the so-called “social hospitalization” or warehousing of the elderly in expensive medical facilities. This paper seeks to evaluate recent patterns in Japanese LTC use and examine the factors associated with LTC utilization patterns. We show that the use of LTC in Japan – particularly home care – is growing rapidly, as the elderly consumers find subsidized LTC care preferable to and more available than hospitalization. At the same time, regional disparities in terms of entitlement and care use persist and are likely to grow.
TL;DR: The development of group homes for elders with dementia in Japan since the inception of the long-term care insurance program in 2000 is explored, showing one way in which social policy has had a significant influence on the lives of elders suffering from dementia and their families.
Abstract: In this article we explore the development of group homes for elders with dementia in Japan since the inception of the long-term care insurance program in 2000. We suggest that the combination of demographic and policy trends in recent years have created a context in which entrepreneurial activities related to elder care have increased significantly. By focusing on one of the new institutions that has emerged, we show one way in which social policy has had a significant influence on the lives of elders suffering from dementia and their families. Finally, we point out some of the problems that have arisen along with the growth of these new forms of care, such as a lack of involvement by family members in visiting and caring for elders.
Journal Article•
TL;DR: In this paper, the effects of municipal fiscal climates on eligibility assessments in the Japanese system of long-term care insurance (LTCI) were investigated and it was shown that municipalities with more stringent fiscal climates tend to reject more applications for LTCI benefits, almost certainly in the hope of containing benefit expenditures.
Abstract: This paper considers the effects of municipal fiscal climates on eligibility assessments in the Japanese system of long-term care insurance (LTCI). We find that municipalities with more stringent fiscal climates tend to reject more applications for LTCI benefits, almost certainly in the hope of containing benefit expenditures. This would not be a serious problem if financial assistance from the upper levels of government counteracted the adverse effect. However, we also find that the effects of the assistance are almost negligible, despite layers of intergovernmental subsidies for municipal LTCI expenditures. In other words, horizontal equity in Japanese long-term care insurance is compromised for the sake of gatekeeping.
TL;DR: It is argued that the positive contribution of LTCI in the well-being of family care-givers is established, and short-term stay is the most efficient service, followed by home-helper service, and day service is the least efficient.
Abstract: Long-Term Care Insurance (LTCI), introduced in Japan in 2000, is rapidly turning into a system of rationed benefits due to financial difficulty. Based on our survey of 2,530 family care-givers and the Zarit Care-Giver Burden Index, we have examined how LTCI is affecting their subjective burden. We have found that, as Kishida and Tanigaki (2004) had shown, (i) insufficient provision of short-term stays, day services and home-helper services, as well as (ii) disruptive or antisocial behaviors of the elderly, increase the care-giver's burden. We then argue that (iii) these results establish the positive contribution of LTCI in the well-being of family care-givers, (iv) short-term stay is the most efficient service, followed by home-helper service, and day service is the least efficient, and we show that (v) J-ZBIC-8 works well enough for many practical purposes.
TL;DR: In this article, the rationale of long-term care (LTC) insurance purchasing from a statistical analysis of insurance data and a life cycle model is analyzed, and a short survey of the pros and cons of LTC insurance purchase is made.
Abstract: This paper analyses the rationale of long-term care (LTC) insurance purchasing from a statistical analysis of insurance data and a life cycle model. We make a short survey of the pros and cons of LTC insurance purchase. Then risk distributions in the occurrence and duration dimension are estimated on a Spanish portfolio. Calendar effects are estimated besides age and gender. These statistical results are integrated in a life cycle model of savings and insurance purchasing. A numerical illustration is also provided, which leads to an optimal age of 40 years for insurance purchase.
TL;DR: With the aging of society, the dividing line between health and social care has become blurred and older people need a complex combination of both services.
Abstract: When the NHS was established, ‘health care’ was made available to all and free at the point of delivery, but ‘social care’ remained with the local authorities and continued to be provided after a means-test (i.e. only for the poor). With the aging of society, the dividing line between health and social care has become blurred. Older people need a complex combination of both services.
TL;DR: A systemic family decisionmaking framework is proposed and tested to understand group long-term care insurance (LTCI) enrollment decisions and reveals very good predictive efficacy for the overall conceptual framework with a pseudo R2 value of .687.
Abstract: This study proposes and tests a systemic family decisionmaking framework to understand group long-term care insurance (LTCI) enrollment decisions A random sample of public employees who were offered group LTCI as a workplace benefit were examined Findings reveal very good predictive efficacy for the overall conceptual framework with a pseudo R2 value of 687, and reinforced the contributions of factors within the family system Enrollees were more likely to have discussed the decision with others, used information sources, and had prior experience when compared to non-enrollees Perceived health status, financial knowledge, attitudes regarding the role of private insurance, risk taking, and coverage features were additional factors related to enrollment decisions The findings help to inform policymakers about the potential of LTCI as one strategy for financing long-term care
TL;DR: It is shown that the demand for LTC in Japan - particularly home care - is growing rapidly, as elderly consumers find subsidized LTC care preferable to and more available than hospitalization.
Abstract: The recently-enacted Japanese long-term care (LTC) system was implemented to reduce so-called social hospitalization or warehousing of the elderly in expensive medical facilities. This paper seeks to evaluate recent patterns in Japanese LTC use and examine the factors associated with LTC utilization patterns. We show that the demand for LTC in Japan - particularly home care - is growing rapidly, as elderly consumers find subsidized LTC care preferable to and more available than hospitalization. At the same time, regional disparities in care persist and are likely to grow.
Patent•
30 Dec 2008
TL;DR: In this paper, a flexible, varying long term care insurance program for use as part of combination long-term care products is generated. But the authors do not specify the process variables.
Abstract: Flexible, varying long term care insurance programs for use as parts of combination long term care products are generated. Input variables such as issue age, targeted present value and year-to-year premium relationship are supplied, as are some members of a set of process variables. A non-supplied process variable is calculated based on the input variables and the supplied process variables. An insurance program based on the supplied variables and the calculated process variable is then generated, such that the premium schedule increases (or alternatively, increases and decreases) over time to at least one leveling point, at which premiums become level. A combination long term care product is produced by coupling the generated insurance program with a life insurance program or annuity.
Posted Content•
TL;DR: In this article, the authors considered the possible effects of broader-based local government, especially extended associations, in Japanese local public finance, and they mainly analyzed scale effects in public long-term care insurance expenditure, with their results indicating a U shaped expenditure structure.
Abstract: This paper considers the possible effects of broader-based local government, especially extended associations, in Japanese local public finance. In order to evaluate the expenditure of extended association, our new approach is to apply unique index called financial index classified by similar types. We mainly analyze scale effects in public long-term care insurance expenditure, with our results indicating a U shaped expenditure structure. We also show that expenditures associated with extended associations decrease more rapidly than ordinary municipal expenditures. These findings suggest that expenditure of appropriate population size extended associations larger than single municipality.
TL;DR: 新予防給付創設にあわせて要介護区分も見直され, あらたに要支援 1および 2という医分が新�bnされた.
Abstract: 今回の見直しでは,一貫性・連続性のある総合的な介 護予防システムの確立が謳われ,介護保険枠内の「新予 防給付」と市町村が実施する「地域支援事業」が創設さ れた.新予防給付創設にあわせて要介護区分も見直され, あらたに要支援 1および 2という区分が新設された.新 予防給付は,居宅要支援者(要支援者であって,居宅に おいて支援を受けるもの)を対象とし, 「介護予防サービ ス」と「地域密着型介護予防サービス」とからなる.介 護予防サービスとしては介護予防訪問介護や介護予防訪 問入浴介護などが,地域密着型介護予防サービスとして は介護予防認知症対応型通所介護や介護予防小規模多機 能型居宅介護などが新設された.介護予防サービスは, これも新たに設置された地域包括支援センターの保健師 が作成する「介護予防サービス計画」に基づいて提供さ れることになった.地域包括支援センターは,総合相談・ 支援や他に必要なサービスとの連携,包括的・継続的マ ネジメントの実施,高齢者の虐待防止のための相談や権 利擁護などの包括的支援事業を行う.地域包括支援セ ンターは,介護予防において中心的役割を果たすことが 期待されているが,業務があまりにも多岐に渡るため十 分に機能しうるのか不明である.
TL;DR: Estimates indicate that living arrangements are quite responsive to home health care benefits, and the bulk of the shared-living response occurred through co-residents living in elderly households, which suggests that increases in benefits raised elderly homeownership.
Abstract: We provide empirical evidence on the extent to which long-term care insurance affects the housing and living arrangements of the elderly by examining plausibly exogenous changes in the supply of long-term care insurance through the Medicare program that occurred in the late 1990s. Prior to 1997, Medicare reimbursed home health care agencies on a retrospective-cost basis. Then, starting in October, 1997, as a result of the Balanced Budget Act of 1997 (BBA97), Medicare switched to a system of prospective payments for home health care, which induced state-by-calendar-year variation in the supply of this type of public long-term care insurance. We exploit this variation to econometrically identify the impact on the housing and living arrangements of the elderly, using CPS data from 1995-2000 (before and after the law change). Our estimates indicate that living arrangements are quite responsive to home health care benefits. The estimated elasticity of shared living to benefits is -0.7 over all elderly and -1 for widowed elderly. However, these benefits have little impact on household headship among the elderly. This suggests that the bulk of the shared-living response occurred through co-residents living in elderly households. There is some weak evidence that increases in benefits raised elderly homeownership.
Journal Article•
TL;DR: This article evaluates the efficacy of homecare supported by regional system in intractable neurological disease medical care and adds the report on the development of this regional care system.
Abstract: In order to meet the needs for medical care after discharge from hospital of serious or intractable neurological disease patients, in 1978, Shinrakuen Hospital in Niigata City launched the Continuing Medical Care Section providing home visit by doctors and periodical home nursing. In the article published in 1990 reporting the 13-year practice of this section, the author advocated the necessity of the across-the-board and continuing regional care system in support of homecare and proposed a desirable model. Since then, with the policy shift from hospital care to homecare facing the progress of aging society, various homecare services have been developed. The author opened in 1997 an organized clinic of internal and neurological medicine in Niigata City, and, on the basis of long term care insurance program founded in 2000, put into practice the homecare system of cooperation between the prefectural and municipal administration, medicine and nursing. In this article, based on her article in 1990, the author adds the report on the development of this regional care system and evaluates the efficacy of homecare supported by regional system in intractable neurological disease medical care.
01 Jan 2008
TL;DR: The Lt. Governor's Office on Aging has put together a fact sheet of information that Long Term Care Insurance customers should know as discussed by the authors, which can be found in the fact sheet.
Abstract: The Lt. Governor’s Office on Aging has put together this fact sheet of information that Long Term Care Insurance customers should know.
Patent•
10 Apr 2008TL;DR: In this article, a user may schedule certificates of deposit (CDs) to be consolidated at maturity into an annuity, long term care insurance, or life insurance, by providing information pertaining to their certificates of deposits, such as amount and maturity dates, and recommendations may be provided regarding consolidation by rolling them into annuities or insurance.
Abstract: A user may schedule certificates of deposit (CDs) to be consolidated at maturity into an annuity, long term care insurance, or life insurance. The user provides information pertaining to their certificates of deposits, such as amount and maturity dates, and recommendations may be provided regarding consolidating the CDs by rolling them into annuities or insurance.
01 Jan 2008
Posted Content•
01 Dec 2008
TL;DR: In this article, the authors present the results of a study on the implementation of the Dependent Care Law in Spain, showing that "a lot of work is still to be done in order to reach the objectives proposed by the Law".
Abstract: The passing of Act 39/2006, of 14th December, on the Promotion of Personal Autonomy and Care for Dependent Persons (known as the Dependent Care Law) has created the fourth pillar of Welfare State in Spain. In order to achieve its efficient implementation, we need to know who and how many individuals should be attended and how much money is needed for the attention. However, the answers to these two questions given until now suggest that a lot of work is still to be done in order to reach the objectives proposed by the Law.