IDEAS home Printed from https://ideas.repec.org/p/crd/wpaper/21001.html
   My bibliography  Save this paper

Nursing Homes in Equilibrium: Implications for Long-term Care Policies

Author

Abstract

We build an equilibrium model of a nursing home market with decision-makers on both sides of the market. On the demand side, heterogeneous households with stochastic needs for long-term care solve dynamic optimization problems, choosing between in-home and nursing-home care. On the supply side, locally competitive nursing homes decide prices and intensities of care given the household demand. The government subsidizes long-term care of the poorest. The quantitative model successfully generates key empirical patterns. Evaluation of long-term care policies shows that the equilibrium approach is important for the welfare and distributional effects of policies targeting either side of the market.

Suggested Citation

  • Tatyana Koreshkova & Minjoon Lee, 2021. "Nursing Homes in Equilibrium: Implications for Long-term Care Policies," Working Papers 21001, Concordia University, Department of Economics.
    • Handle: RePEc:crd:wpaper:21001
    as

    Download full text from publisher

    File URL: https://drtatyana.github.io/NHs_in_equilibrium_2021Jan22.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Matthew Shapiro & Joseph Briggs & Chris Tonetti & Andrew Caplin & John Ameriks, 2016. "Late-in-Life Risks and the Under-Insurance Puzzle," 2016 Meeting Papers 241, Society for Economic Dynamics.
    2. David A. Wise, 2014. "Discoveries in the Economics of Aging," NBER Books, National Bureau of Economic Research, Inc, number wise13-1.
    3. Karen A. Kopecky & Tatyana Koreshkova, 2014. "The Impact of Medical and Nursing Home Expenses on Savings," American Economic Journal: Macroeconomics, American Economic Association, vol. 6(3), pages 29-72, July.
    4. Daniel Barczyk & Matthias Kredler, 2019. "Long‐Term Care Across Europe and the United States: The Role of Informal and Formal Care," Fiscal Studies, John Wiley & Sons, vol. 40(3), pages 329-373, September.
    5. Michael D. Hurd & Pierre-Carl Michaud & Susann Rohwedder, 2014. "The Lifetime Risk of Nursing Home Use," NBER Chapters, in: Discoveries in the Economics of Aging, pages 81-109, National Bureau of Economic Research, Inc.
    6. Mariacristina De Nardi & Eric French & John B. Jones, 2010. "Why Do the Elderly Save? The Role of Medical Expenses," Journal of Political Economy, University of Chicago Press, vol. 118(1), pages 39-75, February.
    7. R. Anton Braun & Karen A. Kopecky & Tatyana Koreshkova, 2019. "Old, Frail, and Uninsured: Accounting for Features of the U.S. Long‐Term Care Insurance Market," Econometrica, Econometric Society, vol. 87(3), pages 981-1019, May.
    8. Warshawsky, Mark & Marchand, Ross, 2017. "Improving the System of Financing Long-Term Services and Supports for Older Americans," Working Papers 07009, George Mason University, Mercatus Center.
    9. 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.
    10. Andrew T. Ching & Fumiko Hayashi & Hui Wang, 2015. "Quantifying The Impacts Of Limited Supply: The Case Of Nursing Homes," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 56, pages 1291-1322, November.
    11. Daniel Barczyk & Matthias Kredler, 2018. "Evaluating Long-Term-Care Policy Options, Taking the Family Seriously," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 85(2), pages 766-809.
    12. Nyman, John A., 1985. "Prospective and `cost-plus' medicaid reimbursement, excess medicaid demand, and the quality of nursing home care," Journal of Health Economics, Elsevier, vol. 4(3), pages 237-259, September.
    13. Stabile, Mark & Laporte, Audrey & Coyte, Peter C., 2006. "Household responses to public home care programs," Journal of Health Economics, Elsevier, vol. 25(4), pages 674-701, July.
    14. Ettner, Susan L, 1994. "The Effect of the Medicaid Home Care Benefit on Long-Term Care Choices of the Elderly," Economic Inquiry, Western Economic Association International, vol. 32(1), pages 103-127, January.
    15. R. Anton Braun & Karen A. Kopecky & Tatyana Koreshkova, 2017. "Old, Sick, Alone, and Poor: A Welfare Analysis of Old-Age Social Insurance Programmes," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 84(2), pages 580-612.
    16. Mommaerts, Corina, 2018. "Are coresidence and nursing homes substitutes? Evidence from Medicaid spend-down provisions," Journal of Health Economics, Elsevier, vol. 59(C), pages 125-138.
    17. John Bailey Jones & Aaron Steelman, 2019. "Lifetime Medical Spending of Retirees," Richmond Fed Economic Brief, Federal Reserve Bank of Richmond, issue May.
    18. Martin B. Hackmann, 2019. "Incentivizing Better Quality of Care: The Role of Medicaid and Competition in the Nursing Home Industry," American Economic Review, American Economic Association, vol. 109(5), pages 1684-1716, May.
    19. Gertler, Paul J., 1989. "Subsidies, quality, and the regulation of nursing homes," Journal of Public Economics, Elsevier, vol. 38(1), pages 33-52, February.
    20. John Ameriks & Andrew Caplin & Steven Laufer & Stijn Van Nieuwerburgh, 2011. "The Joy of Giving or Assisted Living? Using Strategic Surveys to Separate Public Care Aversion from Bequest Motives," Journal of Finance, American Finance Association, vol. 66(2), pages 519-561, April.
    21. John Ameriks & Joseph Briggs & Andrew Caplin & Matthew D. Shapiro & Christopher Tonetti, 2020. "Long-Term-Care Utility and Late-in-Life Saving," Journal of Political Economy, University of Chicago Press, vol. 128(6), pages 2375-2451.
    22. Grabowski, David C., 2001. "Medicaid reimbursement and the quality of nursing home care," Journal of Health Economics, Elsevier, vol. 20(4), pages 549-569, July.
    23. Bertrand Achou, 2020. "Housing in Medicaid: Should it Really Change?," Cahiers de recherche / Working Papers 3, Institut sur la retraite et l'épargne / Retirement and Savings Institute.
    24. Grabowski, David C. & Gruber, Jonathan, 2007. "Moral hazard in nursing home use," Journal of Health Economics, Elsevier, vol. 26(3), pages 560-577, May.
    25. Andrew T. Ching & Fumiko Hayashi & Hui Wang, 2015. "Quantifying The Impacts Of Limited Supply: The Case Of Nursing Homes," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 56(4), pages 1291-1322, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. De Donder, Philippe & Achou, Bertrand & Glenzer, Franca & Lee, Minjoon & Leroux, Marie-Louise, 2023. "At Home versus in a Nursing Home: Long-term Care Settings and Marginal Utility," TSE Working Papers 23-1442, Toulouse School of Economics (TSE).
    2. Achou, Bertrand & De Donder, Philippe & Glenzer, Franca & Lee, Minjoon & Leroux, Marie-Louise, 2022. "Nursing home aversion post-pandemic: Implications for savings and long-term care policy," Journal of Economic Behavior & Organization, Elsevier, vol. 201(C), pages 1-21.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond.
    2. Achou, Bertrand, 2021. "Housing liquidity and long-term care insurance demand: A quantitative evaluation," Journal of Public Economics, Elsevier, vol. 194(C).
    3. Martin B. Hackmann & R. Vincent Pohl & Nicolas R. Ziebarth, 2024. "Patient versus Provider Incentives in Long-Term Care," American Economic Journal: Applied Economics, American Economic Association, vol. 16(3), pages 178-218, July.
    4. Amitabh Chandra & Courtney Coile & Corina Mommaerts, 2023. "What Can Economics Say about Alzheimer's Disease?," Journal of Economic Literature, American Economic Association, vol. 61(2), pages 428-470, June.
    5. repec:dem:wpaper:wp-2023-006 is not listed on IDEAS
    6. Mariacristina De Nardi & Eric French & John Bailey Jones & Rory McGee, 2021. "Why Do Couples and Singles Save During Retirement?," Richmond Fed Economic Brief, Federal Reserve Bank of Richmond, vol. 21(09), pages 1-65, May.
    7. Mariacristina De Nardi & Eric French & John Bailey Jones, 2016. "Savings After Retirement: A Survey," Annual Review of Economics, Annual Reviews, vol. 8(1), pages 177-204, October.
    8. Bertrand Achou & Philippe De Donder & Franca Glenzer & Minjoon Lee & Marie-Louise Leroux, 2023. "At Home versus in a Nursing Home: Long-term Care Settings and Marginal Utility," CIRANO Working Papers 2023s-14, CIRANO.
    9. John Laitner & Dan Silverman & Dmitriy Stolyarov, 2018. "The Role of Annuitized Wealth in Post-retirement Behavior," American Economic Journal: Macroeconomics, American Economic Association, vol. 10(3), pages 71-117, July.
    10. Mariacristina De Nardi & Eric French & John Bailey Jones & Rory McGee, 2021. "Why Do Couples and Singles Save during Retirement? Household Heterogeneity and its Aggregate Implications," NBER Working Papers 28828, National Bureau of Economic Research, Inc.
    11. Bram Wouterse & Arjen Hussem & Albert Wong, 2022. "The risk protection and redistribution effects of long‐term care co‐payments," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(1), pages 161-186, March.
    12. M. Martin Boyer & Philippe De Donder & Claude Denys Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2018. "A Canadian Parlor Room-Type Approach to the Long-Term Care Insurance Puzzle," CIRANO Working Papers 2018s-13, CIRANO.
    13. Mariacristina De Nardi & Eric French & John Bailey Jones, 2016. "Medicaid Insurance in Old Age," American Economic Review, American Economic Association, vol. 106(11), pages 3480-3520, November.
    14. van der Vaart, J & Groneck, M & van Ooijen, R, 2024. "Health Inequalities and the Progressivity of Old-Age Social Insurance Programs," Health, Econometrics and Data Group (HEDG) Working Papers 24/20, HEDG, c/o Department of Economics, University of York.
    15. Siciliani Luigi, 2013. "The Economics of Long-Term Care," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 14(2), pages 343-375, August.
    16. John Bailey Jones & Aaron Steelman, 2019. "Lifetime Medical Spending of Retirees," Richmond Fed Economic Brief, Federal Reserve Bank of Richmond, issue May.
    17. Martin B. Hackmann, 2019. "Incentivizing Better Quality of Care: The Role of Medicaid and Competition in the Nursing Home Industry," American Economic Review, American Economic Association, vol. 109(5), pages 1684-1716, May.
    18. Haizhen Lin, 2015. "Quality Choice And Market Structure: A Dynamic Analysis Of Nursing Home Oligopolies," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 56(4), pages 1261-1290, November.
    19. Achou, Bertrand & De Donder, Philippe & Glenzer, Franca & Lee, Minjoon & Leroux, Marie-Louise, 2022. "Nursing home aversion post-pandemic: Implications for savings and long-term care policy," Journal of Economic Behavior & Organization, Elsevier, vol. 201(C), pages 1-21.
    20. Ethan M. J. Lieber & Lee M. Lockwood, 2019. "Targeting with In-Kind Transfers: Evidence from Medicaid Home Care," American Economic Review, American Economic Association, vol. 109(4), pages 1461-1485, April.
    21. Siha Lee & Kegon Teng Kok Tan, 2023. "Bequest Motives and the Social Security Notch," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 51, pages 888-914, December.

    More about this item

    Keywords

    Long-term Care; Nursing Home; Medicaid.;
    All these keywords.

    JEL classification:

    • D15 - Microeconomics - - Household Behavior - - - Intertemporal Household Choice; Life Cycle Models and Saving
    • E21 - Macroeconomics and Monetary Economics - - Consumption, Saving, Production, Employment, and Investment - - - Consumption; Saving; Wealth
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:crd:wpaper:21001. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Economics Department (email available below). General contact details of provider: https://edirc.repec.org/data/deconca.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.