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Moral hazard and long-term care insurance

Author

Listed:
  • R. Tamara Konetzka

    (University of Chicago)

  • Daifeng He

    (Swarthmore College)

  • Jing Dong

    (IMPAQ International)

  • John A. Nyman

    (University of Minnesota)

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.

Suggested Citation

  • R. Tamara Konetzka & Daifeng He & Jing Dong & John A. Nyman, 2019. "Moral hazard and long-term care insurance," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 44(2), pages 231-251, April.
    • Handle: RePEc:pal:gpprii:v:44:y:2019:i:2:d:10.1057_s41288-018-00119-1
    DOI: 10.1057/s41288-018-00119-1
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    References listed on IDEAS

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    1. Jeffrey R. Brown & Norma B. Coe & Amy Finkelstein, 2007. "Medicaid Crowd-Out of Private Long-Term Care Insurance Demand: Evidence from the Health and Retirement Survey," NBER Chapters, in: Tax Policy and the Economy, Volume 21, pages 1-34, National Bureau of Economic Research, Inc.
    2. Goda, Gopi Shah & Golberstein, Ezra & Grabowski, David C., 2011. "Income and the utilization of long-term care services: Evidence from the Social Security benefit notch," Journal of Health Economics, Elsevier, vol. 30(4), pages 719-729, July.
    3. Goda, Gopi Shah, 2011. "The impact of state tax subsidies for private long-term care insurance on coverage and Medicaid expenditures," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 744-757, August.
    4. Anne Theisen Cramer & Gail A. Jensen, 2006. "Why Don't People Buy Long-Term-Care Insurance?," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 61(4), pages 185-193.
    5. Sloan, Frank A & Norton, Edward C, 1997. "Adverse Selection, Bequests, Crowding Out, and Private Demand for Insurance: Evidence from the Long-Term Care Insurance Market," Journal of Risk and Uncertainty, Springer, vol. 15(3), pages 201-219, December.
    6. Courtemanche, Charles & He, Daifeng, 2009. "Tax incentives and the decision to purchase long-term care insurance," Journal of Public Economics, Elsevier, vol. 93(1-2), pages 296-310, February.
    7. Karlsson, Martin & Mayhew, Les & Rickayzen, Ben, 2007. "Long term care financing in four OECD countries: Fiscal burden and distributive effects," Health Policy, Elsevier, vol. 80(1), pages 107-134, January.
    8. Terza, Joseph V. & Basu, Anirban & Rathouz, Paul J., 2008. "Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling," Journal of Health Economics, Elsevier, vol. 27(3), pages 531-543, May.
    9. Mellor, Jennifer M., 2001. "Long-term care and nursing home coverage: are adult children substitutes for insurance policies?," Journal of Health Economics, Elsevier, vol. 20(4), pages 527-547, July.
    10. Jeffrey R. Brown & Amy Finkelstein, 2008. "The Interaction of Public and Private Insurance: Medicaid and the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 98(3), pages 1083-1102, June.
    11. Karlsson, Martin & Mayhew, Les & Rickayzen, Ben, 2007. "Long term care financing in 4 OECD countries: fiscal burden and distributive effects," Publications of Darmstadt Technical University, Institute for Business Studies (BWL) 34405, Darmstadt Technical University, Department of Business Administration, Economics and Law, Institute for Business Studies (BWL).
    12. Pauly, Mark V, 1990. "The Rational Nonpurchase of Long-term-Care Insurance," Journal of Political Economy, University of Chicago Press, vol. 98(1), pages 153-168, February.
    13. Nyman, John A. & Koc, Cagatay & Dowd, Bryan E. & McCreedy, Ellen & Trenz, Helen Markelova, 2018. "Decomposition of moral hazard," Journal of Health Economics, Elsevier, vol. 57(C), pages 168-178.
    14. John A. Nyman, 1988. "Excess Demand, the Percentage of Medicaid Patients, and the Quality of Nursing Home Care," Journal of Human Resources, University of Wisconsin Press, vol. 23(1), pages 76-92.
    15. Amy Finkelstein & Kathleen McGarry, 2006. "Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 96(4), pages 938-958, September.
    16. Nyman, John A., 1999. "The economics of moral hazard revisited," Journal of Health Economics, Elsevier, vol. 18(6), pages 811-824, December.
    17. Grabowski, David C. & Gruber, Jonathan, 2007. "Moral hazard in nursing home use," Journal of Health Economics, Elsevier, vol. 26(3), pages 560-577, May.
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    Cited by:

    1. Katarzyna Krot & Iga Rudawska, 2021. "How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links," IJERPH, MDPI, vol. 18(8), pages 1-15, April.
    2. Coe, Norma B. & Goda, Gopi Shah & Van Houtven, Courtney Harold, 2023. "Family spillovers and long-term care insurance," Journal of Health Economics, Elsevier, vol. 90(C).
    3. J. Iñaki De La Peña & M. Cristina Fernández-Ramos & Asier Garayeta, 2021. "Cost-Free LTC Model Incorporated into Private Pension Schemes," IJERPH, MDPI, vol. 18(5), pages 1-16, February.
    4. Sano, Kazuaki & Miyawaki, Atsushi & Abe, Kazuhiro & Jin, Xueying & Watanabe, Taeko & Tamiya, Nanako & Kobayashi, Yasuki, 2022. "Effects of cost sharing on long-term care service utilization among home-dwelling older adults in Japan," Health Policy, Elsevier, vol. 126(12), pages 1310-1316.
    5. Jing Dong & Daifeng He & John A. Nyman & R. Tamara Konetzka, 2021. "Wealth and the utilization of long-term care services: evidence from the United States," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 345-366, September.

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