nep-age New Economics Papers
on Economics of Ageing
Issue of 2013‒07‒15
twenty papers chosen by
Claudia Villosio
LABORatorio R. Revelli

  1. The impact of an increase in the legal retirement age on the effective retirement age By Noelia BERNAL; Frederic VERMEULEN
  2. How Portfolios Evolve After Retirement: Evidence from Australia By Alexandra Spicer; Olena Stavrunova; Susan Thorp
  3. Maintaining One's Living Standard at Old Age - What Does That Mean?: Evidence Using Panel Data from Germany By Christian Dudel; Notburga Ott; Martin Werding
  4. Did Age Discrimination Protections Help Older Workers Weather the Great Recession? By David Neumark; Patrick Button
  5. Reallocation of Resources Across Age in a Comparative European Setting By Bernhard Hammer; Alexia Prskawetz; Inga Freund
  6. Old, sick, alone, and poor: a welfare analysis of old-age social insurance programs By R. Anton Braun; Karen A. Kopecky; Tatyana Koreshkova
  7. Labour Market Policies to Promote Growth and Social Cohesion in Korea By Randall S. Jones; Satoshi Urasawa
  8. Restructuring Welfare Spending in Slovenia By Rafal Kierzenkowski
  9. The Funding of State and Local Pensions: 2012-2016 By Alicia H. Munnell; Jean-Pierre Aubry; Josh Hurwitz; Madeline Medenica
  10. Population Ageing and the Growth of Income and Consumption Tax Revenue By Ball, Christopher; Creedy, John
  11. Migration, Location and Provision of Support to Old-Age Parents: The Case of Romania By Zachary Zimmer; Codrina Rada; Catalin Stoica
  12. Testing the Tunnel Effect: Comparison, Age and Happiness in UK and German Panels By Felix FitzRoy; Michael Nolan; Max Steinhardt; David Ulph
  13. Public Spending on Health and Long-term Care: A new set of projections By Christine de la Maisonneuve; Joaquim Oliveira Martins
  14. Pension funds and Market Efficiency: A review By Ashok Thomas; Luca Spataro
  15. Can Automatic Tax Increases Pay for the Public Spending Effects of Population Ageing in New Zealand? By Creedy, John; Gemmell, Norman
  16. Differing types of medical prevention appeal to different individuals By Nicolas BOUCKAERT; Erik SCHOKKAERT
  17. Belgium: Enhancing the Cost Efficiency and Flexibility of the Health Sector to Adjust to Population Ageing By Stéphane Sorbe
  18. Is Geriatric Care Associated with Less Emergency Department Use? By Laura P. D'Arcy; Sally C. Stearns; Marisa E. Domino; Laura C. Hanson; Morris Weinberger
  19. An examination of the validity and reliability of the Caregiver Reaction Assessment Scale among Japanese family caregivers for older members By Ogura, Seiritsu
  20. Two-Period Comparison of Healthcare Demand with Income Growth and Population Aging in Rural China: Implications for Adjustment of the Healthcare Supply and Development By Martine AUDIBERT; Yong HE; Jacky MATHONNAT

  1. By: Noelia BERNAL; Frederic VERMEULEN
    Abstract: We analyze the impact of an increase in the legal retirement age on the effective retirement age in the Netherlands. We do this by means of a dynamic programming model for the retirement behavior of singles. The model is applied to new administrative data that contain very accurate and detailed information on individual incomes and occupational pension entitlements. Our model is able to capture the main patterns observed in the data. We observe that as individuals get older their labor supply declines considerably and this varies by health status. We simulate a soon to be implemented pension reform which aims at gradually increasing the legal retirement age from 65 to 67. The simulation results show a rather small impact on the effective retirement age. Individuals postpone their retirement by only 3 months on average, while differences across individuals mainly depend on their health status.
    Date: 2013–02
  2. By: Alexandra Spicer; Olena Stavrunova; Susan Thorp
    Abstract: Households in many developed economies now reach retirement with lump sums of financial wealth accumulated through defined contribution retirement plans. Managing wealth from individual accumulations and public provision is critical to retirement welfare. We study the dynamics of retirement wealth and asset allocation using the three wealth waves of the Household Income and Labour Dynamics in Australia (HILDA) panel survey. We find significant influences of ageing on asset holdings with older households preferring less risk and more liquidity, while maintaining ownership of the family home. In terms of absolute changes in wealth the average retired household accumulated in 2002-06 and decumulated 2006-10 in line with financial market trends. More diversified households did better. The probability of retired households depleting non-housing. Finally, in contrast to the US, the overall effect of health shocks on the wealth of retired Australian households is minimal.
    Keywords: Retirement wealth; Life-cycle saving; Public pension; Portfolio choice
    JEL: D91 E21 G11
    Date: 2013–06
  3. By: Christian Dudel; Notburga Ott; Martin Werding
    Abstract: How much retirement income is needed in order to maintain one's living standard at old age? As it is difficult to find a firm basis for an empirical treatment of this question, we employ a novel approach to assessing an adequate replacement rate vis- a-vis income in the pre-retirement period. We subject indications regarding satisfaction with current income as collected in the German Socio-Economic Panel (SOEP) to longitudinal analyses, using linear fixed-effects models and fixed-effects ordered logit models as our main analytical tools. We obtain a required net replacement rate of about 87% for the year of entry into retirement as a rather robust result, while replacement rates keeping the living standard unchanged may slightly decline over the retirement period.
    Keywords: Retirement, living standard, replacement rate, pensions, saving, satisfaction
    JEL: D1 D91 H55 J32
    Date: 2013
  4. By: David Neumark; Patrick Button
    Abstract: We examine whether stronger age discrimination laws at the state level moderated the impact of the Great Recession on older workers. We use a difference-in-difference-in-differences strategy to compare older workers in states with stronger and weaker laws, to their prime-age counterparts, both before, during, and after the Great Recession. We find very little evidence that stronger age discrimination protections helped older workers weather the Great Recession, relative to younger workers. The evidence sometimes points in the opposite direction, with stronger state age discrimination protections associated with more adverse effects of the Great Recession on older workers. We suggest that this may be because stronger age discrimination laws protect older workers in normal times, but during an experience like the Great Recession severe labor market disruptions make it difficult to discern discrimination, weakening the effects of stronger state age discrimination protections.
    JEL: J14 J26 J71 J78
    Date: 2013–07
  5. By: Bernhard Hammer; Alexia Prskawetz; Inga Freund
    Abstract: We investigate the reallocation of resources across age and gender in a comparative European setting. Our analysis is based on concepts and data from the National Transfer Accounts (NTA) project, as well as on data from income and time use surveys. We introduce the aggregate NTA life cycle deficit as a concept of an economic dependency ratio. This dependency measure allows for flexible age limits and age-specific levels of economic dependency. We then move beyond the current NTA methodology and study gender differences in the generation of income and extend our analysis by unpaid household work. We find large cross-country differences in the age- and gender-specific levels and type of production activities and consequently in the organisation of the resource reallocation across age. Our results clearly indicate that a reform of the welfare system needs to take into account not only public transfers but also private transfers, in particular the services produced within the households for own consumption (e.g. childcare, cooking, cleaning...).
    Keywords: Ageing, challenges for welfare system, demographic change, welfare state
    JEL: I38 J10
    Date: 2013–07
  6. By: R. Anton Braun; Karen A. Kopecky; Tatyana Koreshkova
    Abstract: Poor health, large acute and long-term care medical expenses, and spousal death are significant drivers of impoverishment among retirees. We document these facts and build a rich, overlapping generations model that reproduces them. We use the model to assess the incentive and welfare effects of Social Security and means-tested social insurance programs such as Medicaid and food stamp programs, for the aged. We find that U.S. means-tested social insurance programs for retirees provide significant welfare benefits for all newborn. Moreover, when means-tested social insurance benefits are of the scale in the United States, all individuals would prefer to be born into an economy with no Social Security. Finally, we find that the benefits of increasing means-tested social insurance are small or negative, if we hold fixed Social Security contributions and benefits at their current levels
    Date: 2013
  7. By: Randall S. Jones; Satoshi Urasawa
    Abstract: Labour market reform to improve growth prospects and reduce inequality is a top priority in the face of rapid population ageing and a dualistic labour market. Sustaining output growth requires policies to mitigate the impact of rapid population ageing by increasing labour inputs from under-employed segments of the population. In particular, female labour participation should be encouraged by better work-life balance and increasing the availability of highquality, affordable childcare. More flexible employment and wage systems would increase the age at which older workers leave firms. For young people, improved vocational education at the secondary and tertiary levels would help overcome the labour mismatch and the overemphasis on tertiary education. Labour market dualism creates serious equity concerns, as non-regular workers face significantly lower wages, precarious jobs, less coverage by social security and less training. A comprehensive approach is required to break down dualism, including reduced employment protection for regular workers, alongside improved social insurance coverage and expanded training for non-regular workers. This Working Paper relates to the 2012 OECD Economic Survey of Korea (<P>Réformer le marché du travail pour stimuler la croissance et améliorer la cohésion sociale en Corée<BR>La réforme du marché du travail pour améliorer les perspectives de croissance et réduire les inégalités est une priorité absolue face au vieillissement rapide de la population et à un marché du travail dual. Pour soutenir la croissance de la production, les autorités coréennes doivent prendre des mesures pour compenser les effets du vieillissement de la population, en renforçant l’apport de travail des catégories de population sous-employés. Il convient notamment de renforcer le taux d’activité des femmes, en leur assurant des conditions d’emploi permettant de mieux concilier vie professionnelle et vie privée et en améliorant l’offre de services de garde de qualité et à moindre coût. Une plus grande flexibilité des systèmes d’emploi et de rémunération permettrait aux travailleurs âgés de poursuivre leur activité professionnelle. Quant aux jeunes, l’amélioration de la formation professionnelle dans le secondaire et le supérieur contribuerait à résoudre les problèmes d’adéquation entre offre et demande de compétences et de survalorisation de l'enseignement supérieur. Le dualisme engendre de graves problèmes d’équité, car les travailleurs temporaires perçoivent des salaires nettement inférieurs, occupent des emplois précaires, bénéficient d’une couverture sociale plus limitée et d’un moindre accès à la formation. Il faut adopter une approche globale pour briser le dualisme, notamment en réduisant la protection de l’emploi pour les travailleurs réguliers, en améliorant la couverture sociale pour les travailleurs non réguliers et en développant les formations offertes à ces travailleurs. Ce Document de travail se rapporte à l’Étude économique de l’OCDE de la Corée, 2012 (
    Keywords: Korea, dualism, employment protection, labour force participation rates, female employment, vocational training, non-regular workers, part-time workers, older workers, work-life balance, labour market, fertility rate, Korean economy, dispatched workers, fixed-term contracts, Corée, taux de participation, travailleurs âgés, dualisme, protection de l'emploi, travailleurs non réguliers, formation professionnelle, travailleurs à temps partiel, activité des femmes, taux de fécondité, équilibre entre travail et vie familiale, travailleurs intérimaires, contrats à durée déterminée, marchés du travail
    JEL: J11 J3 J5 J7
    Date: 2013–06–27
  8. By: Rafal Kierzenkowski
    Abstract: Restoring fiscal sustainability is a major challenge in Slovenia. Yet, the performance in terms of expenditure control is poor and public expenditure on social spending increased briskly during the crisis, significantly more than on average across the OECD. Despite recent progress in reforming the pension system, Slovenia continues to face major age-related spending pressures. Reforming the welfare state would help achieve fiscal consolidation, increase the quality of fiscal adjustment and address long-term fiscal sustainability challenges. This could be done without significantly worsening income inequality, which is low in Slovenia. Despite recent progress, cash transfers do not seem to be sufficiently means tested. Partly driven by generous social transfers, average effective tax rates on returning to work from inactivity and unemployment are high and could be further cut gradually. Efficiency frontier analysis suggests there is scope to improve spending efficiency without undermining the quality of in kind services on secondary education, health care and public administration. There is excess capacity in pre-school and compulsory education and the allocation of tertiary education services is regressive. The delivery of health care could be improved by rationalising inpatient care and enhancing costeffective primary care, which would generate savings in the medium term. Further increasing the effective retirement age and reforming the financing of health and long-term care are the main policy priorities to contain the pressure of population ageing on expenditure. This Working Paper relates to the 2013 OECD Economic Review of Slovenia (<P>Restructurer les dépenses sociales en Slovénie<BR>Restaurer la soutenabilité des finances publiques est un enjeu majeur en Slovénie. Cependant, la maîtrise des dépenses est faible et les dépenses sociales publiques ont fortement augmenté durant la crise – nettement plus qu’en moyenne dans la zone OCDE. En dépit de récentes avancées de la réforme du système de retraite, la Slovénie reste confrontée à de fortes pressions sur les dépenses liées au vieillissement de la population. Une réforme de l’État-providence contribuerait à l’assainissement budgétaire, améliorerait la qualité de l’ajustement budgétaire et relèverait les défis de soutenabilité des finances publiques à long terme. Cette réforme pourrait être menée sans détériorer significativement les inégalités de revenus, qui sont faibles en Slovénie. En dépit de progrès récents, les transferts monétaires ne semblent pas suffisamment soumis à des conditions de ressources. Alimentés en partie par de généreux transferts sociaux, les taux moyens effectifs d’imposition des inactifs et des chômeurs qui retrouvent un emploi sont élevés et pourraient être graduellement réduits. L’analyse des frontières d’efficience laisse entrevoir une marge d’amélioration de l’efficience des dépenses sans obérer pour autant la qualité des prestations en nature dans les domaines de l’enseignement secondaire, des soins de santé et de l’administration publique. Il existe des surcapacités dans l’enseignement préscolaire et obligatoire, et l’allocation des services de l’enseignement supérieur est régressive. La fourniture de soins de santé pourrait progresser en qualité grâce à une rationalisation des soins dispensés dans le cadre d’une hospitalisation et une meilleure efficacité-coût des soins primaires, ce qui engendrerait des économies à moyen terme. Un nouveau recul de l’âge effectif de la retraite et la réforme du financement des soins de santé et de la prise en charge de la dépendance sont les principales priorités de l’action publique afin de contenir la pression qu’exerce le vieillissement de la population sur les dépenses. Ce Document de travail se rapporte à l’Étude économique de l’OCDE de la Slovénie 2013 ( nie-2013.htm)
    Keywords: health, education, long-term care, pension system, fiscal consolidation, Slovenia, sustainability, cash transfers, welfare spending, in-kind benefits, santé, Slovénie, dépenses sociales, assainissement budgétaire, système des retraites, soutenabilité, transferts monétaires, prestations en nature, soins de long terme
    JEL: H62 I18 I28 I38 J14 J26 J65
    Date: 2013–06–14
  9. By: Alicia H. Munnell; Jean-Pierre Aubry; Josh Hurwitz; Madeline Medenica
    Abstract: This 2012 update on the funded status of state/local pensions will be one of the last two based on the Governmental Accounting Standards Board’s(GASB) old provisions, under which assets are reported on an actuarially smoothed basis, the discount rate is the long-run expected rate of return, and the annual required contribution (ARC) serves as a well-defined metric against which to measure the extent to which plan sponsors are meeting their obligations. Under these standards, despite a rising stock market, the rebound in tax revenues, and increased employee contributions, the funded status in 2012 declined slightly. This result, which at first seems surprising, reflects the fact that liabilities continued to grow – albeit at a slower pace compared to the past – while the actuarial value of assets increased only modestly, reflecting asset smoothing procedures that continue to include losses from the 2008-09 market crash. In addition to providing a 2012 update, this brief offers a glimpse of the world when GASB’s new proposals go into effect in 2014 and reports projections for the period 2013-2016 under both the old and new GASB standards. The discussion is organized as follows. The first section reports that the ratio of assets to liabilities for our sample of 126 plans declined from 75 percent in 2011 to 73 percent in 2012. The second section shifts from a snapshot of funded status to sponsors’ required payment. The update shows that the ARC – at 15.3 percent of payrolls – and the percent of ARC paid – at 80 percent – were virtually unchanged between 2011 and 2012. These funded ratios and ARCs, however, are based on promised benefits discounted by the expected long-term yield on plan assets, roughly 8 percent, so the third section revalues liabilities using the riskless rate, as advocated by most economists for reporting purposes. The fourth section provides a preview on funding under GASB’s new provisions and compares the new GASB-funded ratios with those produced by the current standards. The fifth section projects funded ratios for our sample plans for 2013-16 under three alternative economic scenarios and under both the old and new GASB standards. The final section concludes that while the shift in GASB standards will make monitoring funding more difficult, the public pension landscape should improve over the next few years if financial markets do not collapse again.
    Date: 2013–07
  10. By: Ball, Christopher; Creedy, John
    Abstract: This paper investigates the implications of population ageing and changes in labour force participation rates for projections of revenue obtained from personal income taxation and a consumption tax (in the form of a broad-based goods and services tax). A projection model is presented, involving changing age-income profiles over time for males and females. The model is estimated and applied to New Zealand over the period 2011-2062.
    Keywords: Aging population, Taxation, New Zealand,
    Date: 2013–07–05
  11. By: Zachary Zimmer; Codrina Rada; Catalin Stoica
    Abstract: The combined demographic developments of population aging and high rates of migration of young adults are consequential for older parents who face a potential decline in support from adult children. These developments also impact the lives of migrant adults who face the challenge of providing support to aging parents from a distance. Systematic data that allow examination of associations between the location of migrants and the provision of support to aging parents are difficult to find for Eastern Europe, a region undergoing enormous demographic and socio-economic transition. Using recently collected data from Romania, a country facing both rapid aging and out-migration, and building upon a family altruism framework, this study models provision of monetary and instrumental support as a function of migrant’s location of residence, location of their siblings in relation to parents, and other characteristics that fall under domains of parental need, ability of migrant to provide, and predisposing characteristics of migrant and parent. Models are run using a mixed methods approach accounting for the random effects at the family level. Results indicate international migrants are more likely to give money while those migrating within Romania are more likely to provide instrumental support. Regardless of type of support or location of migrant, the probability of support increases when other sources are less available and when a parent has greater need. Results provide support for the altruistic framework and help to build upon the understanding of intergenerational exchanges within rapidly changing demographic environments.
    Keywords: population aging; migration; intergenerational support; Romania JEL Classification: F22; F24; N30; R23
    Date: 2013
  12. By: Felix FitzRoy (University of St. Andrews); Michael Nolan (University of Hull); Max Steinhardt; David Ulph (University of St. Andrews)
    Abstract: In contrast to previous results combining all ages we find positive effects of comparison income on happiness for the under 45s, and negative effects for those over 45. In the BHPS these coefficients are several times the magnitude of own income effects. In GSOEP they cancel to give no effect of effect of comparison income on life satisfaction in the whole sample, when controlling for fixed effects, and time-in-panel, and with flexible, age-group dummies. The residual age-happiness relationship is hump-shaped in all three countries. Results are consistent with a simple life cycle model of relative income under uncertainty.
    Keywords: subjective life-satisfaction, comparison income, reference groups, age, welfare
    JEL: D10 I31 J10
    Date: 2013–07–09
  13. By: Christine de la Maisonneuve; Joaquim Oliveira Martins
    Abstract: This paper proposes a new set of public health and long-term care expenditure projections till 2060, following up on the previous set of projections published in 2006. It disentangles health from longterm care expenditure as well as the demographic from the non-demographic drivers, and refines the previous methodology, in particular by better identifying the underlying determinants of health and long-term care spending and by extending the country coverage to include BRIICS countries. A costcontainment and a cost-pressure scenario are provided together with sensitivity analysis. On average across OECD countries, total health and long-term care expenditure is projected to increase by 3.3 and 7.7 percentage points of GDP between 2010 and 2060 in the cost-containment and the cost-pressure scenarios respectively. For the BRIICS over the same period, it is projected to increase by 2.8 and 7.3 percentage points of GDP in the cost-containment and the cost-pressure scenarios respectively.
    Keywords: ageing populations, longevity, public health expenditures, long-term care expenditures, demographic and non-demographic effects, projection methods
    JEL: H51 I12 J11 J14
    Date: 2013–06–26
  14. By: Ashok Thomas; Luca Spataro
    Abstract: The literature on the relationship between pension funds development and market efficiency has been flourishing in the past decades. In this paper we provide an updated review of the theoretical and empirical advances in this field of study, with particular focus on the effects that pension funds exert on labor markets, financial markets and economic growth.
    Keywords: Pension funds, Job Mobility and Labor Force participation, Capital Markets
    JEL: G23 J62 C23
    Date: 2013–07–08
  15. By: Creedy, John; Gemmell, Norman
    Abstract: This paper examines the extent to which projected aggregate tax revenue changes, association with population ageing over the next 50 years, can be expected to finance expected increases in social welfare expenditures. Projections from two separate models, dealing with social expenditures and income tax and GST revenue, are used. The results suggest that the modest projected required increase in the overall average tax rate over the next 50 years can be achieved automatically by adjusting income tax thresholds using an index of prices rather than wages. Based on evidence about the New Zealand tax system over the last 50 years, comparisons of average and marginal tax rates suggest that such an increase may be feasible and affordable. The paper discusses the range of considerations involved in deciding if this automatic increase in the aggregate average tax rate, via real fiscal drag of personal income taxes, is desirable compared with alternative fiscal policy changes.
    Keywords: Taxation, Aging population, Public spending, Fiscal policy,
    Date: 2013
  16. By: Nicolas BOUCKAERT; Erik SCHOKKAERT
    Abstract: We analyse participation in medical prevention with an expected utility model that is sufficiently rich to capture diverging features of different prevention procedures. We distinguish primary and secondary prevention (with one or two rounds) for both fatal or non-fatal diseases. Moreover, we introduce a flexible relationship between the specific disease for which the prevention procedure is set up and the general background health of the individual. We show how these various possibilities change the comparative statics of the prevention decision and we test the differential predictions with data from SHARE (Survey of Health, Ageing and Retirement in Europe) about participation in mammography, dental caries screening and .u vaccination.
    Date: 2013–05
  17. By: Stéphane Sorbe
    Abstract: Belgium has a good record in delivering accessible care, but adaptation to population ageing will be complicated by the fragmentation of responsibilities in the healthcare system and a strong reliance on government regulations. The organisation of the system could be rationalised by giving sickness funds a more active role as promoters of cost-efficiency, better aligning the incentives of the different levels of government and focussing on medium-term budgeting. At the level of care providers, better information flows and incentive structures could facilitate addressing practice and efficiency variations and supplier-induced demand. This notably involves completing the shift to pathology-based budgets in hospitals, more capitation in the remuneration of doctors and measures to tackle the high spending on drugs. Once incentives for cost-efficiency are in place, a shift towards a more demand-driven system could be encouraged by phasing out over-prescriptive hospital regulations. In addition, relative remunerations of doctors should be revised regularly to ensure an adequate supply per specialty. In long-term care, home care, which is generally cost-efficient, could be further encouraged by giving more autonomy to patients to organise their care. This Working Paper relates to the 2013 OECD Economic Survey of Belgium (<P>Belgique : améliorer l'efficience et la flexibilité du secteur de la santé pour s'adapter au vieillissement de la population<BR>La Belgique a su se doter de services de santé accessibles, mais le morcellement des responsabilités au sein du système et le poids de la réglementation risquent de rendre l’adaptation au vieillissement de la population difficile. Le système pourrait être organisé plus simplement en donnant aux caisses d’assurance maladie (mutualités) un rôle plus actif dans l’amélioration de l’efficience, en alignant mieux les incitations des différents niveaux d’administration et en mettant l’accent sur la budgétisation à moyen terme. Au niveau des prestataires de santé, une meilleure circulation de l’information et de meilleures structures incitatives pourraient contribuer à atténuer les variations en termes de pratiques et d’efficience, ainsi qu’à lutter contre la demande induite par les prestataires eux-mêmes. Pour ce faire, il s’agit notamment d’achever la transition vers des budgets hospitaliers fondés sur les pathologies, d’augmenter la part de la rémunération forfaitaire des médecins et de mettre en place des mesures visant à diminuer le niveau élevé des dépenses en médicaments. Une fois que des mesures destinées à améliorer l’efficience seront en place, l’adoption d’un système davantage axé sur la demande pourrait être encouragée en supprimant progressivement les règles hospitalières excessivement normatives. En outre, les rémunérations relatives des médecins devraient être révisées régulièrement afin d’obtenir une offre adaptée dans chaque domaine de spécialité. S’agissant des soins de longue durée, la prise en charge à domicile, qui est globalement efficace au regard de son coût, pourrait être encore plus encouragée en laissant les patients organiser plus librement les soins dont ils bénéficient. Ce Document de travail se rapporte à l’Étude économique de l’OCDE de la Belgique, 2013 (
    Keywords: health, Belgium, population ageing, long-term care, hospital, pharmaceuticals, sickness funds, santé, vieillissement de la population, soins de longue durée, Belgique, médicaments, caisses d’assurance maladie (mutualités)
    JEL: H51 I11 I18
    Date: 2013–06–25
  18. By: Laura P. D'Arcy; Sally C. Stearns; Marisa E. Domino; Laura C. Hanson; Morris Weinberger
    Keywords: Geriatric Care, Primary Care, Nursing Home, Emergency Department
    JEL: I
    Date: 2013–01–30
  19. By: Ogura, Seiritsu
    Abstract: Objectives: Recent studies suggest the need to adjust the construct of the Caregiver Reaction Assessment Scale among the family caregivers according to different social norms and differential public services. The aim of this study is to examine the reliability of the original five-subscale CRA and to evaluate the four-subscale CRA proposed by Malhotra, Chan, Malhotra, and Ostbye (2012) among the Japanese family caregivers of old people. Method: I conducted confirmatory factor analysis of the original Given’s Caregiver Reaction Assessment scale among Japanese family caregivers for older persons and found its fit to be less than satisfactory. I then conducted exploratory factor analysis and modified CRA scale for a better fit. Results: The second confirmatory factor analysis of a modified four-factor CRA model, similar to the one developed by Manhotra et al., (2012), showed an acceptable fit. Furthermore, I checked group invariance between the two important groups of family caregivers in Japan-married women caring for parents-in-law and women caring for own parents-and confirmed configural and metric invariance of the modified (18-item four-factor) scale. Conclusion: Thus I believe my 18-item four-factor CRA is a good empirical instrument for evaluating both positive and negative effects of informal caregiving in Japan, and possibly in some other countries in Asia.
    Keywords: family caregivers, Caregiver Reaction Assessment, confirmatory factor analysis, group invariance, psychometrics
    Date: 2013–06
  20. By: Martine AUDIBERT; Yong HE; Jacky MATHONNAT (Centre d'Etudes et de Recherches sur le Développement International)
    Abstract: We estimate the evolution of healthcare demand under the influence of income growth and population aging with two samples of patients surveyed in the same regions, but with an interval of 18 years in rural China and with mixed logit to deal with heterogeneity. In accordance with theoretical and inductive inferences, it is found that healthcare price effects decreased and became more heterogeneous. Aging impact overweighed income growth impact, resulting in increasing distance effect and patients' preference to proximity. In the face of this demand change, the adjustment of governmental supply should be to promote small and middle-sized healthcare providers. However during this period to cope with urbanization, the Chinese policy consisted of privileging large hospitals. This has led to a higher share of patients, especially the aging patients, to choose self-care and a higher share of poorer patients to suffer from catastrophic health expenditures. This finding carries broad implications for rural health policy-making on, along with income growth, population aging and urbanization, how to provide better coverage of rural areas by enough qualified and multifunctional small and middle-sized healthcare providers in the developing world.
    Keywords: Two-period healthcare demand comparison, mixed logit model, price and distance effects, heterogeneity, insurance, rural China
    JEL: I1 C5 D1
    Date: 2013

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