IDEAS home Printed from https://ideas.repec.org/p/eti/dpaper/25030.html
   My bibliography  Save this paper

Universal Insurance with In-kind Transfers: The welfare effects of long-term care insurance in Japan

Author

Listed:
  • Minamo MIKOSHIBA

Abstract

This study assesses the welfare implications of Japan’s public long-term care insurance (LTCI) system, focusing on the significance of a universal insurance system with in-kind benefits, in a rich overlapping generations model characterized by two-sided altruism. The welfare effects of the LTCI reform are influenced by caregiver labor productivity and generosity of the means-tested welfare program. When caregiver productivity is low, universal LTCI offering cash benefits can improve welfare more effectively than a system with in-kind benefits, despite the positive impact of the in-kind policy on caregiver labor supply. Cash benefits can maintain positive welfare effects while simultaneously reducing government spending on LTCI. Eliminating universal LTCI transfers the burden of care to families and increases reliance on welfare programs, partially offsetting reductions in government expenditure.

Suggested Citation

  • Minamo MIKOSHIBA, 2025. "Universal Insurance with In-kind Transfers: The welfare effects of long-term care insurance in Japan," Discussion papers 25030, Research Institute of Economy, Trade and Industry (RIETI).
    • Handle: RePEc:eti:dpaper:25030
    as

    Download full text from publisher

    File URL: https://www.rieti.go.jp/jp/publications/dp/25e030.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Wojciech Kopczuk & Joseph P. Lupton, 2007. "To Leave or Not to Leave: The Distribution of Bequest Motives," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 74(1), pages 207-235.
    2. Hanaoka, Chie & Norton, Edward C., 2008. "Informal and formal care for elderly persons: How adult children's characteristics affect the use of formal care in Japan," Social Science & Medicine, Elsevier, vol. 67(6), pages 1002-1008, September.
    3. Schmitz, Hendrik & Westphal, Matthias, 2017. "Informal care and long-term labor market outcomes," Journal of Health Economics, Elsevier, vol. 56(C), pages 1-18.
    4. Ami Ko, 2022. "An Equilibrium Analysis of the Long-Term Care Insurance Market," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 89(4), pages 1993-2025.
    5. Tauchen, George, 1986. "Finite state markov-chain approximations to univariate and vector autoregressions," Economics Letters, Elsevier, vol. 20(2), pages 177-181.
    6. 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.
    7. Roozbei Hosseini & Karen Kopecky & Kai Zhao, 2022. "The Evolution of Health over the Life Cycle," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 45, pages 237-263, July.
    8. K. Bolin & B. Lindgren & P. Lundborg, 2008. "Informal and formal care among single‐living elderly in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 393-409, March.
    9. Minchung Hsu & Tomoaki Yamada, 2019. "Population Aging, Health Care, and Fiscal Policy Reform: The Challenges for Japan," Scandinavian Journal of Economics, Wiley Blackwell, vol. 121(2), pages 547-577, April.
    10. 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.
    11. Selahattin İmrohoroğlu & Sagiri Kitao & Tomoaki Yamada, 2016. "Achieving Fiscal Balance In Japan," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 57(1), pages 117-154, February.
    12. 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.
    13. Anand, Priyanka & Dague, Laura & Wagner, Kathryn L., 2022. "The role of paid family leave in labor supply responses to a spouse's disability or health shock," Journal of Health Economics, Elsevier, vol. 83(C).
    14. 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.
    15. Johannes Geyer & Thorben Korfhage, 2015. "Long‐term Care Insurance and Carers' Labor Supply – A Structural Model," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1178-1191, September.
    16. Van Houtven, Courtney Harold & Norton, Edward C., 2004. "Informal care and health care use of older adults," Journal of Health Economics, Elsevier, vol. 23(6), pages 1159-1180, November.
    17. 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.
    18. Norma B. Coe & Courtney Harold Van Houtven, 2009. "Caring for mom and neglecting yourself? The health effects of caring for an elderly parent," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 991-1010, September.
    19. Charles, Kerwin Kofi & Sevak, Purvi, 2005. "Can family caregiving substitute for nursing home care?," Journal of Health Economics, Elsevier, vol. 24(6), pages 1174-1190, November.
    20. Luisa Fuster & Ayşe İmrohoroğlu & Selahattin İmrohoroğlu, 2007. "Elimination of Social Security in a Dynastic Framework," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 74(1), pages 113-145.
    21. Meghan M. Skira, 2015. "Dynamic Wage And Employment Effects Of Elder Parent Care," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 56(1), pages 63-93, February.
    22. Charles Yuji Horioka, 2002. "Are the Japanese Selfish, Altruistic or Dynastic?," The Japanese Economic Review, Japanese Economic Association, vol. 53(1), pages 26-54, March.
    23. Bernheim, B Douglas & Shleifer, Andrei & Summers, Lawrence H, 1986. "The Strategic Bequest Motive," Journal of Labor Economics, University of Chicago Press, vol. 4(3), pages 151-182, July.
    24. Mariacristina De Nardi & Eric French & John Bailey Jones & Rory McGee, 2025. "Why Do Couples and Singles Save during Retirement? Household Heterogeneity and Its Aggregate Implications," Journal of Political Economy, University of Chicago Press, vol. 133(3), pages 750-792.
    25. Kitao, Sagiri, 2015. "Fiscal cost of demographic transition in Japan," Journal of Economic Dynamics and Control, Elsevier, vol. 54(C), pages 37-58.
    26. İmrohoroğlu, Ayşe & Zhao, Kai, 2018. "The chinese saving rate: Long-term care risks, family insurance, and demographics," Journal of Monetary Economics, Elsevier, vol. 96(C), pages 33-52.
    27. Jesus Bueren, 2023. "Long-Term Care Needs and Savings in Retirement," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 49, pages 201-224, July.
    28. Yamada, Hiroyuki & Shimizutani, Satoshi, 2015. "Labor market outcomes of informal care provision in Japan," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 79-88.
    29. Bonsang, Eric, 2009. "Does informal care from children to their elderly parents substitute for formal care in Europe?," Journal of Health Economics, Elsevier, vol. 28(1), pages 143-154, January.
    30. Junya Hamaaki & Masahiro Hori & Keiko Murata, 2019. "The intra-family division of bequests and bequest motives: empirical evidence from a survey on Japanese households," Journal of Population Economics, Springer;European Society for Population Economics, vol. 32(1), pages 309-346, January.
    31. Cox, Donald, 1987. "Motives for Private Income Transfers," Journal of Political Economy, University of Chicago Press, vol. 95(3), pages 508-546, June.
    32. Sugawara, Shinya & Nakamura, Jiro, 2014. "Can formal elderly care stimulate female labor supply? The Japanese experience," Journal of the Japanese and International Economies, Elsevier, vol. 34(C), pages 98-115.
    33. 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.
    34. Kitao, Sagiri & Mikoshiba, Minamo, 2020. "Females, the elderly, and also males: Demographic aging and macroeconomy in Japan," Journal of the Japanese and International Economies, Elsevier, vol. 56(C).
    35. Oshio, Takashi & Usui, Emiko, 2018. "How does informal caregiving affect daughters’ employment and mental health in Japan?," Journal of the Japanese and International Economies, Elsevier, vol. 49(C), pages 1-7.
    36. Charlet Yuji Horioka, 2002. ""Are the Japanese Selfish, Altruistic, or Dynastic?" (in Japanese)," CIRJE J-Series CIRJE-J-70, CIRJE, Faculty of Economics, University of Tokyo.
    37. Lee M. Lockwood, 2018. "Incidental Bequests and the Choice to Self-Insure Late-Life Risks," American Economic Review, American Economic Association, vol. 108(9), pages 2513-2550, September.
    38. Davidoff, Thomas, 2010. "Home equity commitment and long-term care insurance demand," Journal of Public Economics, Elsevier, vol. 94(1-2), pages 44-49, February.
    39. Capatina, Elena, 2015. "Life-cycle effects of health risk," Journal of Monetary Economics, Elsevier, vol. 74(C), pages 67-88.
    40. Meghan M. Skira, 2015. "Dynamic Wage And Employment Effects Of Elder Parent Care," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 56, pages 63-93, February.
    41. 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.
    42. Bauer, Jan Michael & Sousa-Poza, Alfonso, 2015. "Impacts of Informal Caregiving on Caregiver Employment, Health, and Family," IZA Discussion Papers 8851, Institute of Labor Economics (IZA).
    43. Arnaud Lefranc & Fumiaki Ojima & Takashi Yoshida, 2014. "Intergenerational earnings mobility in Japan among sons and daughters: levels and trends," Journal of Population Economics, Springer;European Society for Population Economics, vol. 27(1), pages 91-134, January.
    44. 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.
    45. Bick, Alexander & Choi, Sekyu, 2013. "Revisiting the effect of household size on consumption over the life-cycle," Journal of Economic Dynamics and Control, Elsevier, vol. 37(12), pages 2998-3011.
    46. Daniel Barczyk & Sean Fahle & Matthias Kredler, 2023. "Save, Spend, or Give? A Model of Housing, Family Insurance, and Savings in Old Age," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 90(5), pages 2116-2187.
    47. Roozbei Hosseini & Karen Kopecky & Kai Zhao, 2022. "The Evolution of Health over the Life Cycle," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 45, pages 237-263, July.
    48. Gunji, Hiroshi & Miyazaki, Kenji, 2011. "Estimates of average marginal tax rates on factor incomes in Japan," Journal of the Japanese and International Economies, Elsevier, vol. 25(2), pages 81-106, June.
    49. 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.
    50. 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.
    51. 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.
    52. Braun, R. Anton & Joines, Douglas H., 2015. "The implications of a graying Japan for government policy," Journal of Economic Dynamics and Control, Elsevier, vol. 57(C), pages 1-23.
    53. Corina Mommaerts, 2025. "Long-Term Care Insurance and the Family," Journal of Political Economy, University of Chicago Press, vol. 133(1), pages 1-52.
    54. Max Groneck, 2017. "Bequests and Informal Long-Term Care: Evidence from HRS Exit Interviews," Journal of Human Resources, University of Wisconsin Press, vol. 52(2), pages 531-572.
    55. Hagiwara, Reona, 2024. "Welfare effects of health insurance reform: The role of elastic medical demand," Economic Modelling, Elsevier, vol. 141(C).
    56. Michael G. Palumbo, 1999. "Uncertain Medical Expenses and Precautionary Saving Near the End of the Life Cycle," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 66(2), pages 395-421.
    57. Selahattin İmrohoroğlu & Sagiri Kitao & Tomoaki Yamada, 2016. "Achieving Fiscal Balance In Japan," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 57, pages 117-154, February.
    Full references (including those not matched with items on IDEAS)

    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. Taiyo FUKAI & Hidehiko ICHIMURA & Sagiri KITAO & Minamo MIKOSHIBA, 2021. "Medical Expenditures over the Life Cycle: Persistent Risks and Insurance," Discussion papers 21073, Research Institute of Economy, Trade and Industry (RIETI).
    2. Daniel Barczyk & Sean Fahle & Matthias Kredler, 2023. "Save, Spend, or Give? A Model of Housing, Family Insurance, and Savings in Old Age," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 90(5), pages 2116-2187.
    3. 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.
    4. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond.
    5. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    6. Ando Michihito & Furuichi Masato & Kaneko Yoshihiro, 2021. "Does universal long-term care insurance boost female labor force participation? Macro-level evidence," IZA Journal of Labor Policy, Sciendo & Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), vol. 11(1), pages 1-50, May.
    7. Max Groneck, 2017. "Bequests and Informal Long-Term Care: Evidence from HRS Exit Interviews," Journal of Human Resources, University of Wisconsin Press, vol. 52(2), pages 531-572.
    8. Tatyana Koreshkova & Minjoon Lee, 2020. "Nursing Homes in Equilibrium: Implications for Long-term Care Policies," Working Papers wp414, University of Michigan, Michigan Retirement Research Center.
    9. 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.
    10. Yoko Niimi, 2016. "The “Costs” of informal care: an analysis of the impact of elderly care on caregivers’ subjective well-being in Japan," Review of Economics of the Household, Springer, vol. 14(4), pages 779-810, December.
    11. Rory McGee & Eric French & John Bailey Jones, 2022. "Saving After Retirement," University of Western Ontario, Departmental Research Report Series 202213, University of Western Ontario, Department of Economics.
    12. Jesus Bueren, 2023. "Long-Term Care Needs and Savings in Retirement," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 49, pages 201-224, July.
    13. Hagiwara, Reona, 2024. "Welfare effects of health insurance reform: The role of elastic medical demand," Economic Modelling, Elsevier, vol. 141(C).
    14. 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.
    15. Ono, Taiki, 2024. "Bequests and wealth inequality in Japan," Journal of the Japanese and International Economies, Elsevier, vol. 72(C).
    16. Achou, Bertrand, 2021. "Housing liquidity and long-term care insurance demand: A quantitative evaluation," Journal of Public Economics, Elsevier, vol. 194(C).
    17. Mariacristina De Nardi & Eric French & John Bailey Jones & Rory McGee, 2025. "Why Do Couples and Singles Save during Retirement? Household Heterogeneity and Its Aggregate Implications," Journal of Political Economy, University of Chicago Press, vol. 133(3), pages 750-792.
    18. Jiayi Wen & Xiaoqing Yu, 2024. "Insuring Long-Term Care in Developing Countries: The Interaction between Formal and Informal Insurance," Papers 2408.14243, arXiv.org.
    19. Cristina Vilaplana Prieto & Sergi Jiménez-Martín, 2015. "Unmet needs in formal care: kindling the spark for caregiving behavior," International Journal of Health Economics and Management, Springer, vol. 15(2), pages 153-184, June.
    20. de Bresser, Jochem & Knoef, Marike & van Ooijen, Raun, 2022. "Preferences for in-kind and in-cash home care insurance," Journal of Health Economics, Elsevier, vol. 84(C).

    More about this item

    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:eti:dpaper:25030. 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: TANIMOTO, Toko (email available below). General contact details of provider: https://edirc.repec.org/data/rietijp.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.