On children's motives to influence parents' long-term care insurance purchase: evidence from Switzerland.

Long-term care (LTC) is not only a concern for elderly individuals but also for their adult children, as the latter often provide financial support and informal care to their elderly dependents. Adult children may therefore have strong incentives to have their parents purchase LTC insurance. Using data from a 2019 Swiss survey, this article first identifies a set of variables, including self-reported interest about LTC insurance, whether elderly parents live with their children and if the latter have provided informal help with personal care, which help predict the interest of adult children in having their parents covered against LTC risk. Second, it investigates the main characteristics of children's motives for influencing their parents to purchase LTC insurance, which are classified as either altruistic, i.e. related to parental well-being, or self-interested, i.e. related to the child's well-being. The results offer valuable insights for both policymakers and insurers when designing public LTC policies and LTC insurance products.

On the effect of uncertainty on personal vaccination decisions.

This study investigates the effect of ambiguity on personal vaccination decisions. We first characterize the vaccination decision in the absence of ambiguity. We then show that uncertainty about the probability of side effects and the efficacy of the vaccine always reduces take-up under ambiguity aversion. However, uncertainty about the underlying disease, being the probability of sickness or the probability of a severe course of disease, may either encourage or discourage vaccination. Our results are relevant for policy because reducing uncertainty associated with the vaccine always has the desired effect whereas reducing uncertainty associated with the disease may have unintended consequences.

The effect of long-term care public benefits and insurance on informal care from outside the household: empirical evidence from Italy and Spain.

This article uses cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) database to test the effect of both long-term care (LTC) public benefits and insurance on the receipt of informal care provided by family members living outside the household in Italy and Spain. The choice of Italy and Spain comes from the fact that informal care is rather similar in these two countries while their respective public LTC financing systems are different. Our results support the hypothesis of LTC public support decreasing the receipt of informal care for Spain while reject it for Italy. They tend to confirm that the effect of public benefits on informal care depends on the typology of public coverage for LTC whereby access to proportional benefits negatively influences informal care receipt while access to cash benefits exerts a positive effect. Our results also suggest that private LTC insurance complements the public LTC financing system in place.

On Portfolios of Preventive Decisions for Multiple Health Risks - Evidence from US-Based Data.

Individuals face multiple health risks and therefore can undertake many preventive activities simultaneously, thus creating a portfolio of preventive activities. In this article, we first investigate the determinants likely to influence the composition of portfolios of preventive activities. Second, we look at the interactions between preventive activities. We use the US Behavioral Risk Factor Surveillance System survey data set conducted in 2016, comprising 22,510 observations from 50 states and US territories. Our results show that information-related variables, in particular, being aware of illness, having access to information and having a personal doctor, increase the portfolio size of preventive activities. We also show that vaccinations tend to be performed together with screening activities and to a lower extent with exercising.

Means-tested public support and the interaction between long-term care insurance and informal care.

This paper investigates theoretically how the structure of means-tested public long-term care (LTC) support influences the relationship between LTC insurance and informal care. Three types of public support encountered in various means-tested LTC schemes are examined. First, the level to be considered for means-testing only takes into account the level of wealth of the recipient without considering the cost of LTC or the possible insurance benefits. Second, the public support also considers the LTC needs of the recipient. Third, the means-test structure takes into consideration insurance benefits as well. Our results show that the optimal levels of insurance and informal care as well as their relationship are strongly influenced by the ways means-tested public support for LTC is structured, which have important implications in terms of public policy for the financing of LTC needs.

Decision Thresholds and Changes in Risk for Preventive Treatment.

This paper investigates the notion of treatment threshold for preventive treatment with potential side effects in the context of changes in risk. Changes in risk are defined by the concept of nth-order stochastic dominance and concern the effectiveness of preventive treatment, side effects, severity of the potential disease, and comorbidity risk. The impact of a riskier environment on the probability of disease threshold above which the preferable decision is to undergo preventive treatment is shown to depend on both mixed risk averse individual preferences and the configuration of increase in risk considered. These results suggest that neglecting differences between risks when evaluating the treatment threshold is likely to lead to substantial errors in most cost-benefit applications for preventive treatment.

Financing long-term care: ex ante, ex post or both?

This paper attempts to examine the heterogeneity in the public financing of long-term care (LTC) and the wide-ranging instruments in place to finance LTC services. We distinguish and classify the institutional responses to the need for LTC financing as ex ante (occurring prior to when the need arises, such as insurance) and ex post (occurring after the need arises, such as public sector and family financing). Then, we examine country-specific data to ascertain whether the two types of financing are complements or substitutes. Finally, we examine exploratory cross-national data on public expenditure determinants, specifically economic, demographic and social determinants. We show that although both ex ante and ex post mechanisms exist in all countries with advanced industrial economies and despite the fact that instruments are different across countries, ex ante and ex post instruments are largely substitutes for each other. Expenditure estimates to date indicate that the public financing of LTC is highly sensitive to a country's income, ageing of the population and the availability of informal caregiving.

Crowding out of long-term care insurance: evidence from European expectations data.

Long-term care (LTC) is the largest insurable risk that old-age individuals face in most western societies. However, the demand for LTC insurance is still ostensibly small in comparison with the financial risk. One explanation that has received limited support is that expectations of either 'public sector funding' and 'family support' crowd out individual incentives to seek insurance. This paper aims to investigate further the aforementioned motivational crowding-out hypothesis by developing a theoretical model and by drawing on an innovative empirical analysis of representative European survey data containing records on individual expectations of LTC funding sources (including private insurance, social insurance, and the family). The theoretical model predicts that, when informal care is treated as exogenously determined, expectations of both state support and informal care can potentially crowd out LTC insurance expectations, while this is not necessarily the case when informal care is endogenous to insurance, as happens when intra-family moral hazard is integrated in the insurance decision. We find evidence consistent with the presence of family crowding out but no robust evidence of public sector crowding out.

On insuring and caring for parents' long-term care needs.

When adult children are financially responsible for their parents, they can take considerable interest in the amount of their parents' long-term care (LTC) insurance. In this paper, we look at the optimal levels of LTC insurance and of informal care, and at the link between these two decisions when the child, who provides informal care, is also the decision-maker with regard to LTC insurance. Interestingly, results differ depending on the degree of both parental and child altruism and indicate either complementarity or substitutability between insurance and informal care. In particular, we show in the presence of child altruism that insurance stimulates the offer of informal care, contrary to the case where the insurance decision is made by the elderly parent. We also investigate how exogenous shocks with respect to the opportunity cost of informal care, initial wealth levels and bequests modify simultaneously the optimal level of insurance and informal care.

Priority setting in health care and higher order degree change in risk.

This paper examines how priority setting in health care expenditures is influenced by the presence of uncertainty about the severity of the illness and the effectiveness of medical treatment. We provide necessary and sufficient conditions on social preferences under which a social planner will allocate more health care resources to populations at higher risk. Changes in risk are defined by the concept of stochastic dominance up to order n. The shape of the social utility function and an equity weighting function are used to model the inequality aversion of the social planner. We show that for higher order risk changes, the usual conditions on preferences such as prudence or relative risk aversion are not necessarily required to prioritise health care when there are different levels of uncertainty associated with otherwise similar patient groups.

On priority setting in preventive care resources.

Using an expected utility approach, we show that within a population that differs with respect to the probability of developing a disease, the allocation of preventive care resources should be prioritized based on the efficiency of prevention and not on whether individuals are at high or low risk of developing the disease. Should the efficiency of prevention be the same within the population, we show that the gravity of the disease, the presence of co-morbidities and the existence of uncertainty on health status can alternatively be considered so as to prioritize among preventive care resources.

Prudence and optimal prevention for health risks.

Empirical evidence suggests the existence of a positive relationship between fear of sickness (FS) - as measured by the level of future utility lost when sickness occurs - and the level of effort to prevent the occurrence of sickness. By looking theoretically at this issue, we develop new results on the determinants of optimal prevention for health risks. In particular, we show that a sufficient condition to pursue more prevention for an individual with a higher FS than another is to have lower prudence in Kimball's (1990) sense, whatever the distribution of risk. These findings reinforce the role of prudence as a main determinant of the optimal level of prevention.