Showing papers on "Long-term care insurance published in 2019"

Projection of Long-Term Care Costs in China, 2020–2050: Based on the Bayesian Quantile Regression Method

Abstract: The aging population in China highlights the significance of elderly long-term care (LTC) services. The number of people aged 65 and above increased from 96 million in 2003 to 150 million in 2016, some of whom were disabled due to chronic diseases or the natural effects of aging on bodily functions. Therefore, the measurement of future LTC costs is of crucial value. Following the basic framework but using different empirical methods from those presented in previous literature, this paper attempts to use the Bayesian quantile regression (BQR) method, which has many advantages over traditional linear regression. Another innovation consists of setting and measuring the high, middle, and low levels of LTC cost prediction for each disability state among the elderly in 2020–2050. Our projections suggest that by 2020, LTC costs will increase to median values of 39.46, 8.98, and 20.25 billion dollars for mild, moderate, and severe disabilities, respectively; these numbers will reach 141.7, 32.28, and 72.78 billion dollars by 2050. The median level of daily life care for mild, moderate, and severe disabilities will increase to 26.23, 6.36, and 27 billion dollars. Our results showed that future LTC cost increases will be enormous, and therefore, the establishment of a reasonable individual-social-government payment mechanism is necessary for the LTC system. The future design of an LTCI system must take into account a variety of factors, including the future elderly population, different care conditions, the financial burden of the government, etc., in order to maintain the sustainable development of the LTC system.

The Long-Term Care Insurance System in Japan: Past, Present, and Future.

Abstract: The Japanese population is rapidly aging. The proportion of people aged ≥65 was 27.3% in 2016, the highest in the world. Japan achieved universal health coverage for medical care in 1961 with the introduction of the National Health Insurance (NHI) system. However, increasing expenditure on inpatient care for old people became a significant issue in society. At that time, tax-supported in-home services were mainly for old people with low incomes and little care given by family. To tackle these problems, universal health coverage for long-term care was introduced in 2000 under the Long-Term Care Insurance (LTCI) system. People aged ≥65 who satisfied the eligibility criteria and those aged 40-64 with age-related diseases are entitled to receive long-term care services at home or in facilities, irrespective of income level and availability of family caregiving. The practical benefits in kind under the LTCI system for family caregivers have been demonstrated. However, because of a recent increase in long-term care costs, especially facility-based costs, it may be necessary to give more support to family (informal) caregivers who participate in home-based long-term care. Health services research using nationwide claims data would help sustain the LTCI system through evidence-based policymaking. Recent studies have explored how to prevent deterioration of care need levels among residents of long-term care welfare facilities and how to promote a shift from facility-based to home-based long-term care services. By 2025, as the baby boomer generation is projected to reach the age of 75, the Japanese government is planning to establish a community-based integrated care system. Harmonization between long-term care and medical care, involving the informal sector and nonprofit organizations, would mitigate the increasing cost of both the NHI and LTCI systems. To achieve this, more research is warranted to understand how long-term care, medical care, and informal care can be effectively integrated in the community.

Old, Frail, and Uninsured: Accounting for Features of the U.S. Long‐Term Care Insurance Market

Abstract: Half of U.S. 50‐year‐olds will experience a nursing home stay before they die, and one in ten will incur out‐of‐pocket long‐term care expenses in excess of $200,000. Surprisingly, only about 10% of individuals over age 62 have private long‐term care insurance (LTCI) and LTCI takeup rates are low at all wealth levels. We analyze the contributions of Medicaid, administrative costs, and asymmetric information about nursing home entry risk to low LTCI takeup rates in a quantitative equilibrium contracting model. As in practice, the insurer in the model assigns individuals to risk groups based on noisy indicators of their nursing home entry risk. All individuals in frail and/or low‐income risk groups are denied coverage because the cost of insuring any individual in these groups exceeds that individual's willingness‐to‐pay. Individuals in insurable risk groups are offered a menu of contracts whose terms vary across risk groups. We find that Medicaid accounts for low LTCI takeup rates of poorer individuals. However, administrative costs and adverse selection are responsible for low takeup rates of the rich. The model reproduces other empirical features of the LTCI market including the fact that owners of LTCI have about the same nursing home entry rates as non‐owners.

China's policy experimentation on long-term care insurance: Implications for access.

Abstract: China's population is aging rapidly, while the traditional long-term care (LTC) system that heavily relies on families is eroding. In response, China has embarked on a journey of policy experimentation for long-term care insurance (LTCI) since 2016, launching LTCI pilots in 15 pioneer cities. These pilots have a great diversity in participation, eligibility, and provision. This paper estimates the prevalence of LTC needs and analyzes the impact of the LTCI pilots on access. Although substantial progress has been achieved, the overall coverage of LTCI is still relatively small, and a large proportion of vulnerable people needing LTC seem to be left behind because of the strict eligibility criteria. This analysis suggests that future policy experimentation on LTCI reform in China needs to address the following pressing policy issues: expanding the coverage of LTCI; narrowing rural-urban disparities in access; improving access for vulnerable subpopulations; and reducing the heavy reliance on institutional care.

Correlation between the Barthel Index and care need levels in the Japanese long-term care insurance system.

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Research on long-term care insurance: status quo and directions for future research

Abstract: We provide a structured literature review of long-term care (LTC) insurance using main path analysis, a mathematical tool to identify the most significant paths in a citation network. We identify three major research areas (financing, demand, and insurability) and systematically evaluate them based on standard frameworks. We further review established and innovative (insurance) solutions for LTC financing. Our results illustrate the immense difficulties of insuring LTC both on the demand side (e.g., low value of consumption while in care, existence of substitutes) and supply side (e.g., lack of predictability and asymmetric information), explaining the marginal contribution of insurance mechanisms to LTC financing. Combined products that bundle the risks, and public–private partnerships that integrate LTC into the pension systems might help to overcome the insurability limitations. In addition, alternative financing methods that go beyond the idea of risk pooling (LTC bond, LTC put option, equity release) could help to improve the sustainability of LTC financing.

Evaluation of Long-Term Care Insurance Policy in Chinese Pilot Cities.

Abstract: Since 2016, 15 pilot cities in China have implemented a long-term care insurance (LTCI) policy. The aim of this research was to explore the outcomes and evaluate the performance of the LTCI policy in the Chinese pilot cities and estimate the willingness of Chinese citizens to expand the formal implementation of LTCI policy in China. We gathered data from 1500 elderly people aged over 60 years in 15 pilot cities (100 surveys for each city) and the effective response rate was 77.8% (1167/1500). We relied on statistical analysis to elicit the outcomes and performance of LTCI implementation and an ordinal logit regression to analyze the factors associated with the extension of the LTCI policy. We examined factors associated with the perception according to sex, age, degree of disability, choices of care, living location, number of children, and monthly income. Among these factors, the relationship between living location and number of children of the family and the outcomes and performance of the LTCI policy in the pilot cities was significant. The rest of the factors showed no significance with the implementation of the LTCI in Chinese pilot cities. This study is among the first to explore the attitudes of Chinese citizens among those who have benefited from the LTCI policy in the pilot cities and contributes to identifying the outcomes of the LTCI in pilot cities to assist policymakers in their further implementation in China.

Moral hazard and long-term care insurance

Abstract: In private long-term care insurance markets, moral hazard is central to pricing and long-run robustness of the market, yet there is remarkably little evidence on the extent to which moral hazard is present in long-term care insurance. We use Health and Retirement Study data from 1996 to 2014 to assess moral hazard in nursing home and home care use in private long-term care insurance, employing a combination of propensity score matching and instrumental variables approaches. We find evidence of significant moral hazard in home care use and a potentially meaningful but noisy effect on nursing home use. Policymakers designing incentives to promote private long-term care insurance should consider the consequences of moral hazard.

Impact of Outpatient Rehabilitation Service in Preventing the Deterioration of the Care-Needs Level Among Japanese Older Adults Availing Long-Term Care Insurance: A Propensity Score Matched Retrospective Study.

Abstract: Outpatient rehabilitation (OR) and outpatient day long-term care (ODLC) services are frequently used by older adult patients in Japan. However, there is a need to clarify that OR service, which has more rehabilitation professionals than ODLC, has the role of providing rehabilitation. This retrospective study examined the impact of OR services by comparing the two services based on City A data from the care-needs certification survey conducted between 2015 to 2017. We performed a propensity score matched analysis to compare the changes in the care level and function of OR and ODLC users after two years. The results showed that OR users showed a lower deterioration in care levels and less decline in the activities of daily living (ADL) in dementia and adaptation to social life. In the analysis of older adults requiring support, OR users had a lower deterioration in care levels and less decline in the ADL in dementia and behavioral and psychological symptoms than ODLC users did. There was no difference between the two services with respect to older adults requiring long-term care. The OR service has had an increasingly preventive effect on the deterioration of care levels compared to the ODLC service, which was particularly evident in older adults requiring support.

Increase in direct social care costs of Alzheimer's disease in Japan depending on dementia severity

Abstract: AIM With the aging population, costs of direct social support for patients with Alzheimer's disease have grown and will continue to increase. The purpose of the present study was to estimate the cost of direct social support for Alzheimer's disease under long-term care insurance in Japan. METHODS This cross-sectional study included 169 patients with Alzheimer's disease or mild cognitive impairment who visited a memory clinic and were followed over time. Dementia severity, use of care services and costs were analyzed. RESULTS The use of direct social support and costs increased significantly between patients with mild, moderate and severe dementia (P < 0.001). In particular, the use of day services and short stay services increased with the severity of dementia (P < 0.001). Similar findings were obtained when participants were stratified by long-term care insurance care levels. Of 169 participants, 49 had not applied for long-term care insurance, although their dementia severity was not different from support-need level 1 and care-need level 1. Logistic regression analysis of "did not apply" and "applied and certified" groups showed significant differences not only in dementia severity, but also in age (odds ratio 1.112, 95% confidence interval 1.037-1.193, P = 0.003) and living arrangements (odds ratio 0.257, 95% confidence interval 0.076-0.862, P = 0.028). CONCLUSIONS As the number of patients with Alzheimer's disease increases, direct social costs will increase. The findings of this study might help standardize the type of direct social support provided after diagnosis of Alzheimer's disease and contribute to the development of cost-effective care for these patients. Geriatr Gerontol Int 2019; 19: 1023-1029.

To borrow or insure? Long term care costs and the impact of housing

Abstract: We assess the impact of housing, the availability of reverse mortgages and long-term care (LTC) insurance on a retiree’s optimal portfolio choice and consumption decisions using a multi-period life cycle model that takes into consideration individual longevity risk, health shocks and house price risk. We determine how much an individual should borrow against their home equity and how much to insure health care costs with LTC insurance. We introduce an endogenous grid method, along with a regression based approach, to improve computational efficiency and avoid the curse of dimensionality. Our results confirm that borrowing against home equity provides higher consumption in earlier years and longevity insurance. LTC insurance transfers wealth from healthy states to disabled states, but reduces early consumption because of the payment of insurance premiums. Housing is an illiquid asset that is important in meeting bequest motives, and it reduces the demand for LTC insurance for the wealthy. We show that the highest welfare benefits come from combining a reverse mortgage with LTC insurance because of strong complementary effects between them. This result highlights the benefits of innovative products that bundle these two products together.

Study and Comparison of Elderly Care System in Germany and China

Abstract: In the context of globalization and information revolution, the interactions in terms of knowledge exchange between developed and developing countries in the world have became more and more intensified in many aspects. This thesis focuses on the analytic study and bilateral comparison of elderly care systems in Germany and China. As one of the most important social security components, elderly care has a huge impact on the social stability and sustainability. Thus, many countries have put it on a strategic position and strive for an ideal, efficient, sustainable and adaptive solution to confront the challenges brought by population aging. Germany, as one of the most developed countries in the world, has established a solid and comprehensive elderly care system based on its social welfare foundation. China, as one of the most rapid developing and populous countries, has undergone a radical demographic change and a rapid aging process in the last several decades, which pose massive challenges for contemporary China. Therefore, a comprehensive study and comparison of the elderly care systems in both countries are of great scientific value for transferring theoretical and practical experiences. In the work, firstly a brief review and comparison of background information with respects to population development and living situation of the elderly in Germany and China are given. Then, the analysis of elderly care system is dissected in the following major dimensions: long-term care insurance (LTCI), forms of elderly care, and nursing education. Establishing a stable and sustainable long-term care insurance is imperative for elderly care system. The construction and development of LTCI in both countries are discussed and bilateral compared. The major forms of elderly care in the two countries, consisting of home care, community care, ambulant care and institutional care, are analyzed. Additionally, the insights of practical and academic nursing education systems in the two countries are depicted as well, such as the present status and future reforms. In the end, the knowledge transfer and potential collaborations are addressed.

A Study on the Long-Term Care Insurance System prepare for the Super-Aged Society

Abstract: Korea is undergoing a change in its population structure, due to economic development, falling birth rates and the development of health care. As the population ages, the number of elderly people who have difficulty in daily life such as dementia and paralysis increases every day. The growth of nuclear families and the increased participation of women in society make it difficult to take care of elderly people who need long-term care at home. As the social problems resulting from this have emerged as serious problems, the government enacted and implemented the Long Term Care Insurance Act to improve the quality of life for the elderly subject to long-term care and to ease the burden of family support in order to solve such problems. Therefore, the present study explores ways to improve legal and institutional aspects, and seek mental and psychological measures for the stability of old life as well as the physical health of welfare.

Long-Term Care in Latin America and the Caribbean? Theory and Policy Considerations

Abstract: This paper discusses theoretical and practical issues related to long-term care (LTC) services in Latin America. Demand for these services will rise as the region undergoes a swift demographic transition from its currently young population to a rapidly aging one, especially since the region’s aging cohorts are more prone to experience a decline in their functional and physical abilities than elderly people elsewhere in the world. We argue that private insurance markets are ill-equipped to provide coverage to meet the need for LTC, while the amount of personal savings required to afford self-insurance would be prohibitively high. In Latin America LTC may not be an immediate priority, but governments are likely to encourage the development of LTC programs as demand for them steadily grows. In particular, policymakers are probably going to focus initially on LTC programs for the poor and vulnerable, for whom affordability of LTC is a greater problem. We therefore study how basic elements of policy design affect cost-effectiveness of LTC programs by means of a formal model. In a simple context where families can provide care themselves or hire care in a market, we find that pro-poor programs are more cost effective when families have the option to receive cash subsidies, as the opportunity cost of providing care is lower for poor families. Moreover, the availability of in-kind and in-cash choices reduces program costs overall by screening families based on their opportunity cost of providing care.

Evaluation of the South Korean national long-term care insurance-funded cognitive function training programme for older people with mild dementia.

Abstract: Objectives despite the extensive literature on the effectiveness of cognitive training, its effectiveness has not been demonstrated within a population-based long-term care system. To provide cognitive training services to older people with mild dementia, Korea introduced a special dementia rating, as a long-term care grades, in the national long-term care insurance in July 2014. These services are only offered to those with the special dementia rating. This study evaluated the national long-term care insurance-funded cognitive function training programme for older people with mild dementia. Methods data were derived from the Korean National Health Insurance Elderly Cohort database between 2008 and 2015. We compared changes in function between the intervention (n = 352) and control (n = 1952) groups before (2014) and after (2015) introduction of the cognitive function training programme. Difference-in-differences analysis was performed, to compare changes in each score between the intervention and control groups before and after introduction of the cognitive function training programme. Results introduction of the cognitive function training programme was associated with significantly less cognitive function decline in the intervention group than in the control groups (β = -3.39; standard errors [SE] = 1.14; P = 0.003). A subgroup analysis revealed that this effect increased in subjects in the youngest group, low income bracket, who had a primary caregiver, who were supported in multiple activities of daily living by the primary caregiver, or who were not living alone. Conclusions introduction of the cognitive function training programme was associated with positive effects on cognitive function.

Receiving the home care service offered by certified care workers prior to a patients' death and the probability of a home death: observational research using an instrumental variable method from Japan

Abstract: Objectives To assess the association between receiving the certified care workers’ home care service, which is provided by non-medical professionals prior to a patients’ death and the probability of a home death. Design Observational research using the full-time translated number of certified care workers providing home care service per member of the population aged 65 or above, during the year prior to patient’s death per municipality as an instrumental variable. Setting The certified care workers’ home care service covered by the public long-term care insurance (LTCI) system in Japan. Participants In total, 1 613 391 LTCI beneficiaries aged 65 or above who passed away, except by an external cause of death, between January 2010 and December 2013 were included in the analysis. Primary outcome measures Death at home or death at other places, including hospitals, nursing homes and clinics with beds. Results Out of all participants, 173 498 (10.8%) died at home. The number of patients who used the certified care workers’ home care service more than once per each month during 1, 2 or 3 months prior to the month of death numbered 213 848, 176 686 and 155 716, respectively. This was associated with an increased probability of death at home by 9.1% points (95% CI 2.9 to 15.3), 10.5% points (3.3 to 17.6) and 11.4% points (3.6 to 19.2), respectively. Conclusions The use of the certified care workers’ home care service prior to death was associated with the increased probability of a home death.

Study on Long-Term Care Insurance on Consumption & Expenses among Beneficiary Households

Abstract: This study used data from the 3rd and 11th year of the Korean Welfare Panel to evaluate the effects of the Long-Term Care Insurance(LTCI) system on the consumption and expenditure of LTCI users' households. The study consisted of program group using LTCI and control group not using. Chi-square and t-test were used for the characteristic differences among the groups, and the difference of consumption expenditure was identified by multiple regression analysis. As a result, LTCI had a statistically significant effect on the health care costs of LTCI users' households, resulting in an increase in health care costs(β=3.06). However, there was no statistically significant effect on the total cost of living, basic cost, education cost, and recreation/entertainment cost. Therefore, in order to show the effect of LTC system, we should try to reduce of self-pay and improve the contents and quality of the service of the LTC system.

Annuities, long-term care insurance, and insurer solvency

Abstract: The market for long-term care (LTC) insurance is much smaller than economic theory predicts. One reason is that premium markups are prohibitively high. We aim at quantifying markups for LTC insurance due to mortality and morbidity risk. To this end, we model a shareholder value maximising insurance company that is subject to solvency regulation. Because liabilities from LTC insurance (which depend on future morbidity and mortality) are more volatile than liabilities from annuities (which only depend on future mortality), capital provisions to ensure compliance with regulatory solvency requirements are higher if an insurance company offers LTC insurance instead of annuities. At the same time, a higher volatility in the LTC insurance segment also implies a higher expected payoff to the insurance company’s shareholders. To quantify which effect prevails and which product policy is optimal, we conduct an empirically calibrated simulation study with stochastic mortality and LTC needs. Our results show that offering LTC insurance increases the upside potential to shareholders, but that effect is more than offset by a higher need for external capital. Consequently, if shareholders are to accept an LTC insurance segment, holders of an LTC insurance policy need to pay considerable markups. The more LTC insurance contracts the insurer has sold, the higher the markups.

Factors Related to the Institutionalization of Older Aged Individuals Using Home- and Community-Based Care Services: Data From the South Korea Long-Term Care Insurance Program, 2008–2013

Abstract: South Korea introduced a public long-term care insurance (LTCI) program in response to its rapidly aging population. This study analyzed the association between living arrangement and caregiver type with institutionalization in LTCI grade 1 (very severe limitations), 2 (severe limitations), and 3 (moderate limitations) beneficiaries using data from the LTCI cohort, 2008 to 2013. The dependent variable was alteration status from home to institutional care within 1 year of receiving home service. Independent variables were living arrangement and primary caregiver type. The analysis was conducted using the generalized estimating equation model. Higher likelihoods of institutionalization were found in individuals living with a non-family member compared to individuals living with their spouses. Individuals without a caregiver or with a paid caregiver were also more likely to experience institutionalization than individuals with a spouse primary caregiver. Our findings underscore the importance of monitoring identified vulnerable groups of individuals to attain LTCI sustainability and enhance elderly quality of life.

Perceived Discrimination and Stigma in the Context of the Long-Term Care Insurance Law from the Perspectives of Arabs and the Jews in the North of Israel

Abstract: The Long-Term Care Insurance Law provides support to older Israelis who wish to remain in their home. The present study evaluated the experience of perceived discrimination and stigma in the context of the law among Arab older adults, their family members, and their paid home care workers. For triangulation purposes, we interviewed 15 National Insurance Institute workers (NII; responsible for implementing the law; 47% Arab), 31 older adults (81% Arab), 31 family members (87% Arab), and six paid home care workers (83% Arab) in the north of Israel. Respondents were queried about their home care experience and their encounter with the NII. Thematic analysis was conducted. Four main themes emerged: (a) a strong sense of perceived discrimination among Arab interviewees, (b) reports suggesting the internalization of stigma and the adoption of negative views regarding the Arab population by some Arab respondents, (c) implicit stigma manifested in claims concerning the Arab population (primarily) as “cheating” the system, and (d) the negation of discrimination of Arabs as reported by Jewish interviewees and NII workers. The findings show that a sense of perceived discrimination is common and colors the experience of service seeking among Arabs. On the other hand, the Jewish interviewees in this study completely negated any discrimination or stigma directed toward Arabs. The findings point to the importance of group affiliation (e.g., minority vs. majority) in interpreting the existence of discrimination. The findings likely have major implications for both service providers and policy-makers and legislators.

Family altruism and long-term care insurance

Abstract: The aim of this paper is to analyse long-term care (LTC) insurance purchase decisions by parents who expect to receive assistance from altruistic children. We first propose a simple theoretical model in which we show that the effect of children’s altruism on parents’ insurance decisions is ambiguous and depends on a number of factors: the degree of substitutability between informal and formal care, the degree of parental altruism, and the curvature of the utility functions. We then run an empirical test using data from the U.S., France, Spain, Germany and Israel, and proxy altruism with assistance provided to healthy parents. We find that the effect of children’s altruism is negative in Germany and Israel but not significant in the United States, France and Spain, which possibly suggests that the different forces identified in the theoretical model offset each other.

Impact of increased long-term care insurance payments on employment and wages in formal long-term care

Abstract: This paper examines the effect of raising Long-term care insurance (LTCI) payments on employment and wages of workers in the long-term care (LTC) industry. Specifically, I use the change in the regional premium in 2012 as an exogenous shock to the insurance fee schedule: the change in the unit price of LTCI service ranges from a decrease of 2.8% to an increase of 4.2%. I find no increase in the number of employees in the establishments, registered under the LTCI scheme, in municipalities where the regional premium increased. The earnings and working hours of LTC workers did not increase, either.

Examining the role of commercial long-term care insurance in long-term care services

Abstract: The purpose of this paper is to explore the role of commercial long-term care insurance (LTCI) in long-term care (LTC) services, and to elucidate the mediating roles of service quality and relationship satisfaction in the relationship between customization and loyalty. In addition, this study offers important recommendations for policy makers in formulating policy aimed at supporting the industry and regulating its customer relationships in life insurers in Taiwan.,Study participants were policyholders of life insurance in Taiwan with experience in purchasing commercial LTCI. They were investigated through in-depth interviews and surveys. The hypotheses were tested using the structural equation modeling (SEM) analysis of variance.,The findings of this study are important for policy makers in formulating policy aimed at supporting the industry and regulating its customer relationships.,This study represents the first attempt to investigate the role of LTCI in LTC services in Taiwan. Likewise, this study improves our understanding of the main issues relating to the effect of customization on policyholder loyalty, and the partially mediating role of service quality and relationship satisfaction in the insurance marketing context.

A Canadian Parlor Room–Type Approach to the Long-Term-Care Insurance Puzzle

Abstract: We examine different hypotheses of the cause of the low market penetration of long-term-care (LTC) insurance in Canada. Our analysis is based on results from a survey of 2,000 Canadians aged betwee...

Fair Long-Term Care Insurance

Abstract: The study of optimal long-term care (LTC) social insurance is generally carried out under the utilitarian social criterion, which penalizes individuals who have a lower capacity to convert resources into well-being, such as dependent elderly individuals or prematurely dead individuals. This paper revisits the design of optimal LTC insurance while adopting the ex post egalitarian social criterion, which gives priority to the worst-off in realized terms (i.e. once the state of nature has been revealed). Using a lifecycle model with risk about the duration of life and risk about old-age dependence, it is shown that the optimal LTC social insurance is quite sensitive to the postulated social criterion. The optimal second-best social insurance under the ex post egalitarian criterion involves, in comparison to utilitarianism, higher LTC benefits, lower pension benefits, a higher tax rate on savings, as well as a lower tax rate on labor earnings.

Long-run consequences of informal elderly care and implications of public long-term care insurance

Abstract: In this paper, I estimate a dynamic structural model of labor supply, retirement, and informal care supply, incorporating labor market frictions and the German tax and benefit system. I find that informal elderly care has adverse and persistent effects on labor market outcomes and therefore negatively affects lifetime earnings, future pension benefits, and individuals'well-being. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that, even though fiscally costly, public long-term care insurance can offset the personal costs of caregiving to a large extent - in particular for low-income individuals.

Uninsured by Choice? A Choice Experiment on Long Term Care Insurance

Abstract: We examine evidence from two unique discrete choice experiments (DCE) on long term care insurance and several of its relevant attributes, and more specifically, choices made by 15,298 individuals in the United States with and without insurance. We study the valuation of the following insurance attributes, namely daily insurance benefit, insurance coverage, the compulsory and voluntary nature of the insurance policy design, alongside the costs (insurance premium) and health requirements This paper investigates respondents' preferences and willingness to pay (WTP) for these care insurance's attributes using a random parameter logit model, and assess the heterogeneity of choice responses using demographic, socioeconomic and attitudinal motivations to segment response to insurance choices. We find that an increase in the insurance premium by an additional 100US$ would reduce insurance uptake by 1pp. Insurance policy uptake is higher when it provides benefits for the lifetime (the monthly marginal WTP being $178.64), and voluntary (the monthly marginal WTP increases by an extra $74.71) as opposed to universal, and when it forgoes health checks (the monthly marginal WTP increases by an extra 28US$).