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

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...

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Bibliographic Details
Published in:The Review of economic studies 2018-04, Vol.85 (2 (303)), p.766-809
Main Authors: BARCZYK, DANIEL, KREDLER, MATTHIAS
Format: Article
Language:English
Subjects:
Altruism
Caregivers
Caregiving
Economic models
Informal care
Innovations
Insurance
Labor supply
Long term care insurance
Medicaid
Reliance
Subsidies
Tax revenues
Taxation
Welfare
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Summary: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.
ISSN:0034-6527
1467-937X
DOI:10.1093/restud/rdx036