Old, Frail, and Uninsured: Accounting for Features of the U.S. Long‐Term Care Insurance Market
Econometrica · 2019 · R. Anton Braun、Karen Kopecky、Tatyana Koreshkova
中文摘要
美国 50 岁人群中有一半将在去世前经历入住养老院，十分之一将承担超过 200,000 美元的自付长期护理费用。令人意外的是，62 岁以上人群中仅有约 10% 拥有私人长期护理保险（LTCI），且 LTCI 的投保率在所有财富水平上都很低。我们在一个定量均衡合约模型中分析医疗补助、管理成本以及关于入住养老院风险的信息不对称对低 LTCI 投保率的贡献。与实际做法一样，模型中的保险公司根据个人入住养老院风险的有噪声指标将其分配到风险组。体弱和/或低收入风险组中的所有个人都会被拒保，因为为这些组中任何个人提供保险的成本超过该个人的支付意愿。可保风险组中的个人会得到一份合约菜单，其条款因风险组而异。我们发现，医疗补助解释了较贫穷个人的低 LTCI 投保率。然而，管理成本与逆向选择是富人低投保率的原因。该模型重现了 LTCI 市场的其他经验特征，包括 LTCI 持有者的养老院入住率与非持有者大致相同这一事实。
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.