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on Economics of Ageing |
| By: | Qian, Yuting; Gettel, Cameron; Su, Jasmine; Grogan, Elyssa F. L.; Cohen, Inessa; Rothenberg, Craig; Chen, Xi; Hwang, Ula |
| Abstract: | Emergency departments are a primary point of contact between older adults and the healthcare system, yet standard emergency care is poorly adapted to the complex needs of geriatric patients. Geriatric Emergency Departments (GEDs) - accredited units that integrate geriatric-trained staff, age-friendly protocols, and post-visit care coordination - have expanded rapidly across the United States, but rigorous evidence on their effectiveness at the national scale remains scarce. This paper provides the first nationally representative estimates of GED effects on hospitalization and mortality among Medicare beneficiaries aged 65 and older. Linking data from the Health and Retirement Study (HRS) to Medicare claims, we estimate multivariable logistic regression models with comprehensive controls for sociodemographic, health, and functional characteristics. We find that older adults treated at a GED were 9.7 percentage points less likely to be hospitalized and 6.1 percentage points less likely to die within 30 days, compared to those treated at a non-GED emergency department. Placebo tests and sensitivity analyses support causal interpretation. However, treatment effect heterogeneity analysis reveals that gains are concentrated among non- Hispanic white patients and adults under age 80; Black and Hispanic older adults exhibit no statistically significant benefit, consistent with persistent disparities in post-discharge care access and social support. These findings suggest that GED accreditation improves downstream health outcomes at scale, but that structural inequities outside the emergency department attenuate benefits for minority patients. Policies targeting both the expansion of GEDs and the broader care infrastructure available to disadvantaged older adults are needed to realize equity gains from the GED model. |
| Keywords: | geriatric emergency department, Medicare, hospitalization, 30-day mortality, racial disparities, health and retirement study, accreditation, aging |
| JEL: | I11 I14 I18 J14 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1736 |
| By: | Tabea Bucher-Koenen; Luisa Wallossek; Joachim Winter |
| Abstract: | Default settings strongly increase pension enrollment, especially when savings incentives are high and choices are complex. We show that the effect is weaker when incentives are low, options are simple, and opting out is easy. We study the nationwide introduction of auto-enrollment for low-income employees in Germany's public pay-as-you-go pension system. We find that automatic enrollment raises participation by 23 percentage points, though most individuals actively opt out. Linking administrative and survey data shows that the default effect is stronger when enrollment incentives are higher and among individuals who lack knowledge of their enrollment status. |
| Keywords: | default-setting, auto-enrollment, pensions, financial literacy |
| JEL: | D14 H55 J26 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12605 |
| By: | Bahnsen, Lewe; Neusius, Thomas |
| Abstract: | In 1995, Germany established a two-tier compulsory long-term care insurance scheme. While the public branch, with its pay-as-you-go character, lacks sustainable financing due to demographic circumstances, the capital-funded private branch is supposed to be sustainably financed through its special financial architecture. However, specific legal regulations restrict the calculation of premiums, as is the case in a free competitive insurance market with capital funding, and make the inclusion of transfer elements necessary. We present a synopsis of actuarial expertise on German private compulsory long-term care insurance. Therefore, we make the existing German-speaking literature available to an international audience. In doing so, we provide a comprehensive overview of how private compulsory long-term care insurance in Germany works. Considering recent debates on reforming long-term care insurance financing, understanding the functioning and sustainability of the private branch is of increasing interest. As the financial strain on the public sector intensifies, questions arise about the potential future role of capital-funded private long-term care insurance. |
| Keywords: | Private long-term care insurance, equivalence principle, capital funding, premiums, ageing provisions, Germany |
| JEL: | G22 I11 I13 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:wifinw:340009 |
| By: | Tuda, Dora; Doorley, Karina; Sándorová, Simona |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:esr:wpaper:wp816 |
| By: | Sangyup Choi (Yonsei University); Chaewon Kim (Yonsei University); Inhwan So (Hongik University) |
| Abstract: | We examine the role of demographic change in long-run real exchange rate (RER) determination. Demographic shifts affect saving and investment behavior, labor supply, and the relative demand for tradable and non-tradable goods, and may therefore influence RERs beyond standard macroeconomic fundamentals. We estimate a panel cointegration model for 75 countries over 1970-2024 that augments a standard long-run RER specification with four demographic variables: the old-age dependency ratio, fertility, life expectancy, and net migration. Demographic variables remain informative even after controlling for productivity. We also complement the baseline specification with a full age-distribution approach, which provides an internally consistent representation of demographic change. Combining the estimated long-run relationships with projections from the United NationsWorld Population Prospects, we construct conditional RER projections through 2050. Economies projected to age more rapidly tend to face long-run real appreciation pressure. |
| Keywords: | Real exchange rate; Demographic changes; Panel cointegration; UNWorld Population Prospects; Out-of-sample projections |
| JEL: | D31 E21 F41 J11 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:yon:wpaper:2026rwp-285 |
| By: | Matteo Buttarazzi |
| Abstract: | In this paper, we derive explicit closed-form solutions for the value function and the associated optimal stopping boundaries in an optimal annuitization problem under a mortality shock. We consider an individual whose retirement wealth is invested in a financial fund following the dynamics of a geometric Brownian motion and has the option at any time to irreversibly convert their wealth into a life annuity. The individual faces a sudden, permanent health deterioration occurring at a random, exponentially distributed time, and the annuitization decision is modelled as an optimal stopping problem across two health states. Our analytical expressions characterise both the value function and the optimal timing of annuitization. The results provide clear economic intuition: the optimal strategy is governed by the critical interplay between the relative attractiveness of the annuity (money's worth), the financial returns from the investment fund, and bequest motives across different health states. A numerical analysis compares the optimal annuitization strategy of an individual facing a health shock against a benchmark case with constant mortality, highlighting how the likelihood and severity of a health shock significantly alter optimal annuitization behaviour. |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2604.09342 |
| By: | Ajin Lee; Maya Rossin-Slater; Becky Staiger; Amanda Su |
| Abstract: | An aging US population has raised important questions regarding the organization, delivery, and funding of long-term services and supports (LTSS), prompting many state Medicaid programs to shift from fee-for-service to managed care models for LTSS delivery. We analyze the effects of transitioning to managed LTSS (MLTSS) on health outcomes among dual-eligible Medicare-Medicaid beneficiaries aged 65 and older in Florida and New York. Using Medicare claims data and a differences-in-differences design leveraging county-by-county MLTSS rollouts, we find that MLTSS leads to a 4.2 percent increase in hospitalizations in Florida, but no significant change in New York. Analysis of preventive care suggests that declining flu vaccination rates in Florida may have contributed to increased hospitalizations from respiratory causes. These findings highlight important differences in MLTSS effects across states and underscore the value of Medicare data for measuring health effects in the dual-eligible population. |
| JEL: | I13 I18 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35055 |
| By: | Schäfer, Holger; Stettes, Oliver |
| Abstract: | Der deutsche Arbeitsmarkt wird in den kommenden Jahren vor großen Herausforderungen stehen, die durch den demografischen Wandel hervorgerufen werden. Die gegenwärtige konjunkturelle Krise und damit einhergehende Schwäche der Arbeitskräftenachfrage ändern nichts an der Tatsache, dass das Arbeitskräftepotenzial dramatisch schrumpft. Damit dies nicht in einen wachstumsbegrenzenden Rückgang des Arbeitsangebots mündet, müssen Mechanismen zur Kompensation greifen: Ausweitung des Potenzials durch Fachkräftezuwanderung, Erhöhung der Erwerbsbeteiligung und Ausweitung der Arbeitszeit. Es muss damit gerechnet werden, dass das Potenzial aus der Zuwanderung begrenzt bleiben wird und sich die Erwerbsbeteiligung bestenfalls in einer längeren Frist erhöhen lässt. Auch das Potenzial, das mit einer Aktivierung Arbeitsloser erschlossen werden könnte, reicht nicht aus. Damit verbleibt die Arbeitszeitverlängerung als eine entscheidende Stellschraube zur Bewältigung der demografischen Lasten. Eine wirkungsvolle Verlängerung der Lebensarbeitszeit ist von den geplanten und zum Teil bereits beschlossenen Maßnahmen der Bundesregierung nicht zu erwarten. Hierfür müsste die Möglichkeit für besonders langjährig Versicherte, ohne Abschläge vorzeitig Rente beziehen zu können, abgeschafft werden. Allgemein müssen die Konditionen für einen vorzeitigen Renteneintritt mit Abschlägen für derzeit langjährig Versicherte dahingehend modifiziert werden, dass die Renteneintrittsentscheidung effektiv in Richtung des gesetzlichen Renteneintrittsalters verschoben wird. Vor diesem Hintergrund sollte auch die Wiedereinführung der Hinzuverdienstgrenze erwogen werden. Eine automatische Anpassung des gesetzlichen Eintrittsalters würde langfristig die Relation der Beitragszahler zu Beitragsempfängern in einer ausgewogenen Balance halten. Die Wochen- oder Jahresarbeitszeit lässt sich nur indirekt politisch steuern, denn sie wird autonom von Arbeitnehmern und Betrieben verhandelt. Der Gesetzgeber kann nur einen Rahmen schaffen, der eine Ausweitung der individuellen Arbeitszeit attraktiv macht. Die im Koalitionsvertrag festgelegten Maßnahmen weisen im Ansatz in die richtige Richtung, bleiben aber Stückwerk und kranken an Problemen im Detail. Die wesentliche Stellschraube besteht in der Verringerung des Abgabenkeils. Erwerbstätige werden bereit sein, länger zu arbeiten, wenn es sich durch ein höheres verfügbares Einkommen auszahlt. Aktuelle Befunde aus der IWBeschäftigtenbefragung 2025 bestätigen, dass das Gros der aufstockungswilligen Beschäftigten die Erwartung haben, die Ausweitung der wöchentlichen Arbeitszeit müsse sich auch lohnen. Darüber hinaus gehören bestehende Regeln sowie politisch diskutierte und avisierte gesetzliche Maßnahmen auf den Prüfstand. In einem "Demografie-Check" muss jede Regelung, die Anreize zu einer Verringerung des Arbeitsangebots setzt, dahingehend bewertet werden, ob der beabsichtigte Zweck die problemverschärfende Wirkung auf das Arbeitsangebot rechtfertigen kann. Befunde aus den IW-Beschäftigtenbefragungen 2024 und 2025 signalisieren, dass auch die Unternehmen durch eine altersgerechte und lebensphasenorientierte Personalpolitik ihren Beitrag dazu leisten können, dass Beschäftigte motiviert werden, mehr und mit Blick auf die Lebensarbeitszeit länger zu arbeiten. Aus Sicht der Beschäftigten ist eine Flexibilisierung von Arbeitszeit und Arbeitsort ein wichtiger Faktor für eine potenzielle Ausweitung der eigenen wöchentlichen Arbeitszeiten. |
| Abstract: | The German labor market will face major challenges in the coming years because of demographic change. The current economic crisis and the associated weakness in labor demand do not alter the fact that the labor force is shrinking dramatically. To prevent this from leading to a decline in the labor supply that would limit growth, compensatory mechanisms must be put in place: expanding potential supply through the immigration of skilled workers, increasing labor force participation, and extending working hours. It must be expected that the potential from immigration will remain limited and that labor force participation can only be increased in the longer term at best. The potential that could be raised by activating the unemployed is also insufficient. This leaves the extension of working hours as a decisive lever for coping with the demographic burden. The measures planned and, in some cases, already decided upon by the federal government are not expected to effectively extend working life. To achieve this, the option for people who have been insured for a long time to take early retirement without reductions would have to be abolished. In general, the conditions for early retirement with reductions for people who have been insured for a long time must be modified in such a way that the decision to retire is effectively postponed towards the statutory retirement age. Against this background, the reintroduction of the additional income limit should also be considered. An automatic adjustment of the statutory retirement age would keep the ratio of contributors to beneficiaries in a balanced equilibrium in the long term. Weekly or annual working hours can only be controlled indirectly by politics, as they are negotiated autonomously by employees and companies. Legislators can only create a framework that makes extending individual working hours attractive. The measures set out in the coalition agreement are a step in the right direction, but they remain piecemeal and suffer from problems in the details. The key lever is to reduce the tax wedge. Employees will be willing to work longer if it pays off in terms of higher disposable income. Findings from the IW Employee Survey 2025 confirm that most employees are willing to increase their working hours if it would be worthwhile. In addition, existing rules and politically debated and announced legislative measures need to be reviewed. In a "demographic check, " every regulation that creates incentives to reduce the labor supply must be evaluated to determine whether the intended purpose can justify the problem-exacerbating effect on the labor supply. Findings from the IW employee surveys in 2024 and 2025 indicate that companies can also contribute to motivating employees to work more and longer in terms of their working life by implementing age-appropriate or life-stage-oriented personnel policies. From the employees' point of view, flexible working hours and locations are an important factor in potentially extending their own weekly working hours. |
| Keywords: | Arbeitskräftepotenzial, Arbeitszeitgestaltung, Altersgrenze, Arbeitsmarktreform, Deutschland |
| JEL: | J11 J21 J26 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:iwkrep:340024 |
| By: | Fadlon, Itzik; Gross, Tal; Hoagland, Alex; Layton, Timothy |
| Abstract: | We use novel Medicare data that link spouses to examine how one spouse's sudden incapacitation affects their partner's need for formal care. A spouse's health shock causes their partner to be 18% more likely to visit a skilled nursing facility. That pattern reflects both a change in health and a shift from informal care to formal care. After one spouse is incapacitated, the other spouse becomes less sensitive to the price of formal care. We explore the implications for optimal health insurance contracts, showing that these within-household spillovers imply that the optimal health insurance contract should provide more generous coverage to those whose spouses are incapacitated relative to those whose spouses are available to provide care. |
| Keywords: | 3801 Applied Economics (for-2020), 3802 Econometrics (for-2020), 38 Economics (for-2020), 4203 Health Services and Systems (for-2020), 42 Health Sciences (for-2020), Health Services (rcdc), Aging (rcdc), Clinical Research (rcdc), Social Determinants of Health (rcdc), Generic health relevance (hrcs-hc), 3 Good Health and Well Being (sdg) |
| Date: | 2026–02–15 |
| URL: | https://d.repec.org/n?u=RePEc:cdl:ucsdec:qt5rw0629r |
| By: | Peng, Xue; Dai, Erbiao |
| Abstract: | To alleviate the growing shortage of care workers, the recruitment of foreign labor has become an important strategy in the care sectors of many high-income countries. However, existing studies on the impacts of foreign care workers--an issue of major concern for host countries--remain limited and report mixed findings. Taking Japan as a case study, this paper empirically examines whether the employment of foreign care workers in the care sector affects the health outcomes of native residents. We use Japanese native mortality rate attributable to care institutions as a proxy for health outcomes and focus on the impact of the share of foreigners among Certified Care Workers (CCWs). Using prefecture-level panel data from 2012 to 2023 and fixed-effects models, we find a statistically significant and negative association between the share of foreigners among CCWs and the native mortality rate attributable to care institutions. However, when applying causal inference methods, the causal effect remains inconclusive. We further examine heterogeneous associations and obtain several noteworthy findings. In addition, pathway analyses suggest that the negative association between the share of foreigners among CCWs and native mortality rates is more likely driven by improvements in the quality, rather than the quantity, of care workforce human capital. Overall, our findings indicate that the employment of foreign CCWs is associated with improved health outcomes for native residents, thereby supporting the continuation of Japan's immigration policy of admitting foreign CCWs in the care sector--a field facing an increasingly severe labor shortage. |
| Keywords: | Certificated care worker, Foreigner, Regional mortality rate, Elderly, Japan |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:agi:wpaper:02000271 |
| By: | Leandro Lyra Braga Dognini |
| Abstract: | This paper bridges social security design and general equilibrium theory to conceive optimally balanced pay-as-you-go systems. The design is based on the backward calculation algorithm from Dognini (2025), which is used to find optimal monetary equilibria of prone-to-savings non-stationary overlapping generations economies with heterogeneous households. In particular, this algorithm makes the design applicable for reforming pay-as-you-go systems in countries undergoing demographic transitions. Due to households balanced budgets under equilibrium prices (i.e., Walras' law), these optimally balanced pay-as-you-go systems resemble the well-known notional accounts systems. The design is illustrated in a simplified framework using the past and forecast demographic and productivity dynamics of Brazil, China, India, Italy, and the United States from 1950 to 2070. |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2604.12125 |
| By: | Tabuga, Aubrey D.; Ocbina, John Joseph S.; Pilar, Kevin Robert B. Jr.; Limqueco, Jorge Kerby B. |
| Abstract: | The Philippines' care economy remains deeply shaped by persistent cultural expectations and gender norms, economic constraints, and other challenges. Filipino women continue to bear the disproportionate burden of unpaid care and domestic work, a dynamic that significantly restricts their participation in the paid economy. As the world faces demographic, technological, social, and climate-related transitions, it is crucial to anticipate how these changes can affect the care economy today and in the future, including women's economic empowerment. This paper characterizes the future demand for care in the context of global and local transitions. It also highlights the implications of enduring gender norms and economic challenges, despite the country's relatively rapid development, as well as the current state of the wider care economy on present and future care provision. Additionally, it examines the role of the government in fostering a sound care economy and its concrete responses through an assessment of publicly provided care facilities. Information reflecting various perspectives was collected through key informant interviews and focus group discussions with stakeholders, including families of the elderly, young children, and persons with disabilities; paid care workers; care facility managers; representatives from government, nongovernmental organizations, academia, development partners; and the private sector. Secondary data from national surveys were also analyzed to understand demand for care at various levels, locations, and income groups. Findings show that future demand for care is likely to be shaped not only by various demographic, technological, social, and economic transitions but also by how the current challenges in the care economy are addressed. Currently, the care landscape is characterized by limited access to care services, an underdeveloped care industry, a shortage of qualified care workers and professionals, an uneven distribution of existing facilities, and a family-oriented social context that reinforces gender norms in care provision. In conclusion, this paper draws insights from its findings and offers recommendations for policy and future research. Comments to this paper are welcome within 60 days from the date of posting. Email publications@pids.gov.ph. |
| Keywords: | future demand for care, gender, children, senior citizen, persons with disabilities, care provision, care services |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:phd:dpaper:dp_2025-66 |