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Long-term care expenditures and investment decisions under uncertainty

Author

Listed:
  • Pablo Garcia Sanchez

    (Banque centrale du Luxembourg, Département Économie et Recherche)

  • Luca Marchiori

    (Banque centrale du Luxembourg, Département Économie et Recherche)

  • Olivier Pierrard

    (Banque centrale du Luxembourg, Département Économie et Recherche)

Abstract

Long-term care (LTC) expenditures for the elderly are high in developed countries and are expected to increase further as the population ages. Additionally, LTC costs vary significantly across individuals and are unknown early in life. In this paper, we introduce uncertainty regarding the timing of future LTC costs into a life-cycle model with endogenous aging. We then analyze how this uncertainty impacts the optimal behavior of agents. Our findings demonstrate that uncertainty reduces health investment during youth and diminishes the effectiveness of health investment subsidies. These results suggest that uncertainty should be carefully considered in models that examine the positive or normative aspects of health investment.

Suggested Citation

  • Pablo Garcia Sanchez & Luca Marchiori & Olivier Pierrard, 2025. "Long-term care expenditures and investment decisions under uncertainty," Journal of Population Economics, Springer;European Society for Population Economics, vol. 38(1), pages 1-23, March.
  • Handle: RePEc:spr:jopoec:v:38:y:2025:i:1:d:10.1007_s00148-025-01075-6
    DOI: 10.1007/s00148-025-01075-6
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    1. Chang, Fwu-Ranq, 1996. "Uncertainty and investment in health," Journal of Health Economics, Elsevier, vol. 15(3), pages 369-376, June.
    2. Elyès Jouini & Clotilde Napp & Diego Nocetti, 2013. "Economic consequences of Nth-degree risk increases and Nth-degree risk attitudes," Journal of Risk and Uncertainty, Springer, vol. 47(2), pages 199-224, October.
    3. Anthony Strittmatter & Uwe Sunde, 2013. "Health and economic development—evidence from the introduction of public health care," Journal of Population Economics, Springer;European Society for Population Economics, vol. 26(4), pages 1549-1584, October.
    4. Holger Strulik, 2004. "Economic growth and stagnation with endogenous health and fertility," Journal of Population Economics, Springer;European Society for Population Economics, vol. 17(3), pages 433-453, August.
    5. Luca Marchiori & Olivier Pierrard, 2023. "Health subsidies, prevention and welfare," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 25(6), pages 1304-1336, December.
    6. Picone, Gabriel & Uribe, Martin & Mark Wilson, R., 1998. "The effect of uncertainty on the demand for medical care, health capital and wealth," Journal of Health Economics, Elsevier, vol. 17(2), pages 171-185, April.
    7. Raj Chetty, 2006. "A New Method of Estimating Risk Aversion," American Economic Review, American Economic Association, vol. 96(5), pages 1821-1834, December.
    8. Greg Kaplan & Benjamin Moll & Giovanni L. Violante, 2018. "Monetary Policy According to HANK," American Economic Review, American Economic Association, vol. 108(3), pages 697-743, March.
    9. Dardanoni, Valentino & Wagstaff, Adam, 1990. "Uncertainty and the demand for medical care," Journal of Health Economics, Elsevier, vol. 9(1), pages 23-38, June.
    10. Carl-Johan Dalgaard & Holger Strulik, 2014. "Optimal Aging And Death: Understanding The Preston Curve," Journal of the European Economic Association, European Economic Association, vol. 12(3), pages 672-701, June.
    11. Giorgio Fabbri & Marie-Louise Leroux & Paolo Melindi-Ghidi & Willem Sas, 2024. "Conditioning public pensions on health: effects on capital accumulation and welfare," Journal of Population Economics, Springer;European Society for Population Economics, vol. 37(2), pages 1-21, June.
    12. Kuhn, Michael & Prettner, Klaus, 2016. "Growth and welfare effects of health care in knowledge-based economies," Journal of Health Economics, Elsevier, vol. 46(C), pages 100-119.
    13. Fanti, Luciano & Gori, Luca, 2011. "Public health spending, old-age productivity and economic growth: Chaotic cycles under perfect foresight," Journal of Economic Behavior & Organization, Elsevier, vol. 78(1), pages 137-151.
    14. Schünemann, Johannes & Strulik, Holger & Trimborn, Timo, 2022. "Optimal demand for medical and long-term care," The Journal of the Economics of Ageing, Elsevier, vol. 23(C).
    15. Skinner, Jonathan, 1988. "Risky income, life cycle consumption, and precautionary savings," Journal of Monetary Economics, Elsevier, vol. 22(2), pages 237-255, September.
    16. A. Sandmo, 1970. "The Effect of Uncertainty on Saving Decisions," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 37(3), pages 353-360.
    17. repec:dau:papers:123456789/12392 is not listed on IDEAS
    18. John Bailey Jones & Aaron Steelman, 2019. "Lifetime Medical Spending of Retirees," Richmond Fed Economic Brief, Federal Reserve Bank of Richmond, issue May.
    19. Fernández-Villaverde, J. & Rubio-Ramírez, J.F. & Schorfheide, F., 2016. "Solution and Estimation Methods for DSGE Models," Handbook of Macroeconomics, in: J. B. Taylor & Harald Uhlig (ed.), Handbook of Macroeconomics, edition 1, volume 2, chapter 0, pages 527-724, Elsevier.
    20. Giorgio Fabbri & Marie-Louise Leroux & Paolo Melindi-Ghidi & Willem Sas, 2024. "Conditioning public pensions on health: effects on capital accumulation and welfare," Post-Print hal-04676430, HAL.
    21. Caballero, Ricardo J, 1991. "Earnings Uncertainty and Aggregate Wealth Accumulation," American Economic Review, American Economic Association, vol. 81(4), pages 859-871, September.
    22. Audrey Laporte & Brian Ferguson, 2007. "Investment in health when health is stochastic," Journal of Population Economics, Springer;European Society for Population Economics, vol. 20(2), pages 423-444, April.
    23. Leroux, M.-L. & Pestieau, P. & Ponthiere, G., 2011. "Longevity, genes and efforts: An optimal taxation approach to prevention," Journal of Health Economics, Elsevier, vol. 30(1), pages 62-76, January.
    24. Jeffrey R. Brown & Amy Finkelstein, 2011. "Insuring Long-Term Care in the United States," Journal of Economic Perspectives, American Economic Association, vol. 25(4), pages 119-142, Fall.
    25. Dimitrios Varvarigos & Intan Zakaria, 2013. "Endogenous fertility in a growth model with public and private health expenditures," Journal of Population Economics, Springer;European Society for Population Economics, vol. 26(1), pages 67-85, January.
    26. Petter Lundborg & Martin Nordin & Dan Olof Rooth, 2018. "The intergenerational transmission of human capital: the role of skills and health," Journal of Population Economics, Springer;European Society for Population Economics, vol. 31(4), pages 1035-1065, October.
    27. Nocetti Diego & Smith William T, 2010. "Uncertainty, the Demand for Health Care, and Precautionary Saving," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 10(1), pages 1-31, August.
    28. Kuhn, Michael & Wrzaczek, Stefan & Prskawetz, Alexia & Feichtinger, Gustav, 2011. "Externalities in a life cycle model with endogenous survival," Journal of Mathematical Economics, Elsevier, vol. 47(4-5), pages 627-641.
    29. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    30. Seierstad, Atle, 2003. "Piecewise deterministic optimal control problems," Memorandum 39/2003, Oslo University, Department of Economics.
    31. Tomiyama, Ken, 1985. "Two-stage optimal control problems and optimality conditions," Journal of Economic Dynamics and Control, Elsevier, vol. 9(3), pages 317-337, November.
    32. Amy Finkelstein & Nathaniel Hendren & Mark Shepard, 2019. "Subsidizing Health Insurance for Low-Income Adults: Evidence from Massachusetts," American Economic Review, American Economic Association, vol. 109(4), pages 1530-1567, April.
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    More about this item

    Keywords

    Health; Long-term care costs; Uncertainty; Stochastic model;
    All these keywords.

    JEL classification:

    • C60 - Mathematical and Quantitative Methods - - Mathematical Methods; Programming Models; Mathematical and Simulation Modeling - - - General
    • D15 - Microeconomics - - Household Behavior - - - Intertemporal Household Choice; Life Cycle Models and Saving
    • D81 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Criteria for Decision-Making under Risk and Uncertainty
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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