The Protective Effects of a Healthy Spouse: Medicare as the Family Member of Last Resort
中文摘要
我们研究配偶提供的非正式照护的价值，以及能否获得此类照护如何影响长期照护保险的最优保障范围与水平。利用美国联邦医疗保险（Medicare）理赔数据和一份新型配偶关联表，我们考察配偶突然失能如何影响其伴侣对正式照护的使用。配偶遭受健康冲击使其伴侣入住护理院的概率增加30%。我们发现，这对伴侣的健康有显著的负面影响，但我们提供的证据表明，伴侣入住护理院的增加在很大程度上源于正式照护对非正式照护的替代。当伴侣失能时，Medicare受益人对正式照护价格的敏感度降低，这与他们对该照护的估值更高以及道德风险减少相一致。我们构建了一个框架来解释这些发现。该框架将正式照护需求水平和需求价格弹性的差异转化为对配偶所提供的非正式照护价值的下界估计。该框架还提示，最优的长期照护保险应以家庭为单位设计，并为无法获得非正式照护的人提供更为优厚的保险保障。
Abstract
We study the value of informal care from a spouse and how access to such care shapes optimal insurance coverage for long-term care. Using Medicare claims and a novel spousal crosswalk, we examine how the sudden incapacitation of a spouse affects their partner's use of formal care. A spouse's health shock increases their partner's probability of a nursing-home stay by 30%. We document significant negative health effects for the partner, but provide evidence that their increase in nursing-home stays is largely driven by substitution from informal care to formal care. When their partners are incapacitated, Medicare recipients become less sensitive to the price of formal care, consistent with a higher valuation of that care and reduced moral hazard. We develop a framework to interpret these findings. The framework translates differences in the level and price elasticity of demand for formal care into a lower-bound estimate of the value of informal care provided by a spouse. It also suggests that optimal insurance for long-term care should be designed at the household level with more generous coverage for those who do not have access to informal care.