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on Economics of Ageing |
| By: | Johannes Geyer; Peter Haan; Mia Teschner-Hofmann; Felix Weinhardt |
| Abstract: | Rising life expectancy and demographic change have increased the share of older workers, making their health and productivity central to aging societies. We study whether longer working lives translate into investments in work-related health before retirement. Exploiting a pension reform in Germany in a Regression Discontinuity Design, we show that women facing longer careers are more likely to apply for work-related rehabilitation, particularly those in poorer health or with weaker labor market attachment. Despite higher application and approval rates, this demand does not translate into higher rehabilitation completion. Together with intermediate outcomes, our findings are most consistent with capacity constraints in program delivery. |
| Keywords: | Rehabilitation, Aging Societies, Health Investments, Pension Reform |
| JEL: | H55 I12 J26 |
| Date: | 2026–09–22 |
| URL: | https://d.repec.org/n?u=RePEc:bdp:dpaper:0110 |
| By: | Arapakis, K.; French, E.; McCauley, J. |
| Abstract: | Most health care for the US population aged 65 and older is publicly funded through Medicare and Medicaid. Despite the massive expenditures of these systems, little is known about how redistributive they are. Using data from the Health and Retirement Study, matched to administrative Medicare, Medicaid, and Social Security earnings records, we estimate the distribution of lifetime Medicare and Medicaid benefits received and the distribution of lifetime taxes paid to finance these benefits. We find that benefits are greatest among the high income, largely because higher-income households live longer. Nonetheless, high income people pay more in the way of taxes. In present discounted values at age 65, households at the bottom of the income distribution gain the most from these programs, driven by high Medicaid benefits and low tax burdens. All income groups gain from these programs for the cohort we study: the lifetime tax contributions did not cover the medical benefits they received. This deficit must be paid by younger cohorts. |
| Keywords: | Medicare, Medicaid, Social Security, Means-Testing, Lifecycle, Savings, House-Hold Finance |
| Date: | 2026–09–21 |
| URL: | https://d.repec.org/n?u=RePEc:cam:camdae:2677 |
| By: | Costa-Font, Joan; Raut, Nilesh |
| Abstract: | Given the high and uncertain costs of long-term care (LTC), insurers commonly rely on medical underwriting to determine eligibility. We examine the impact of the rollout of the Long-Term Care Insurance Partnership (LTCIP) programme—a joint federal–state initiative aimed at promoting private LTCI in the United States by shifting catastrophic costs to Medicaid and reducing insurers' risk exposure—using a difference-in-differences framework with heterogeneous effects by pre-LTCIP health status and chronic conditions. Using longitudinal data, we find that LTCIP increased LTCI take-up among both healthier and higher-risk individuals, with a positive effect of 2.1 percentage points among individuals with chronic conditions and a larger effect of 4.8 percentage points among those without chronic conditions. These findings are consistent with a partial relaxation of underwriting constraints. |
| Keywords: | long-term care partnerships;long-term care insurance;Medicaid;underwriting;difference-in-differences;adverse selection;chronic disease |
| JEL: | I18 H11 H24 |
| Date: | 2026–12–31 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:140540 |
| By: | Hancock, Ruth; Hu, Bo; Wittenberg, Raphael; Mayorga Camus, Joaquín; Pauschardt, Julia |
| Abstract: | This report, prepared by the LSE Care Policy and Evaluation Centre for the Joseph Rowntree Foundation, examines how England’s long-term care charging system distributes costs among older people, local authorities and the NHS. Using linked simulation models, it assesses how care costs are divided between individuals, local authorities and the NHS, with particular attention to whether the system is progressive. The analysis finds that homeownership and partnership status are crucial to understanding people’s exposure to costs. Although non-homeowners generally have lower incomes and savings, many low-income older people own their homes and may therefore be excluded from state support for care-home costs. Even people who qualify for local authority funding can face substantial contributions, while the capital thresholds create sharp cut-off points that make wealth more influential than income in determining who pays. In 2023, total public and private expenditure on long-term care for older people was estimated at £27.7 billion. Individuals accounted for 47% of this through self-funding and charges for local authority-supported care, while public expenditure accounted for 53%. Private contributions represented a greater share of residential care spending than community care spending. The report also finds that the value of a person’s home has a much stronger effect on funding for care homes, where it may be included in the means test, than for community care, where it is disregarded. It further models reforms previously planned but not implemented, combining higher capital limits with an £86, 000 lifetime cap on eligible care costs. Together, these reforms are projected to increase net public expenditure by £4.3 billion in 2033 and £6.3 billion in 2043, in 2023 prices. Although the reforms would generally provide greater benefits to people with more income or wealth, they would also deliver substantial gains to some unpartnered, low-income homeowners with modest housing wealth. The findings underline the importance of considering income, savings, housing wealth, homeownership and partnership status together when designing a fairer long-term care funding system. |
| JEL: | R14 J01 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:141077 |
| By: | Yvan Guillemette |
| Abstract: | This paper presents updated estimates of long-run fiscal gaps for 35 OECD and accession candidate countries using the OECD Global Long-Term Model. The long-run fiscal gap measures the fiscal adjustment required at the 2060 horizon to keep public debt ratios stable near current levels while maintaining current service standards and benefit entitlements. The methodology incorporates several refinements, including projected increases in defence spending and a more detailed treatment of primary expenditure. In the absence of additional policy action, the median country would require a fiscal adjustment of 4.7 percentage points of GDP between 2027 and 2060 to stabilise debt, with substantially larger adjustments in some countries. Population ageing is the main driver of long-run fiscal pressures through higher pension, health and long-term care spending, compounded in many cases by weak initial fiscal positions. The paper also assesses the sensitivity of fiscal gaps to key assumptions and policy scenarios. |
| Keywords: | fiscal pressure, fiscal sustainability, long-run fiscal gap, long-term projection |
| JEL: | C53 E17 H68 O57 H55 |
| Date: | 2026–09–30 |
| URL: | https://d.repec.org/n?u=RePEc:oec:ecoaaa:1877-en |
| By: | Nicola Fuchs-Schündeln; Jonas Jessen; Pinchuan Ong; Jessica Pan |
| Abstract: | We assess whether survey responses to hypothetical policy scenarios can recover actual labor supply responses from policy variation. We study the German Mütterrente, a pension benefit crediting parents for child-rearing, benchmarking against Artmann et al. (forthcoming). Surveying mothers and fathers about a hypothetical reform modeled on that expansion, we find that mothers expect to reduce their labor supply, with an implied marginal propensity to earn of −0.65—close to the quasi-experimental estimate of −0.54. The response is sensible across subgroups, falls mainly on the extensive margin, and spills over to fathers. In the aggregate, spousal predictions match partners’ own reports. |
| Keywords: | marginal propensity to earn, pension reform, hypothetical scenarios |
| JEL: | J22 H55 D84 J26 D10 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12993 |
| By: | Nikolova, Milena (University of Groningen); Angelini, Viola (University of Groningen) |
| Abstract: | As populations age, longer working careers become more essential, and technological advancements may prolong or shorten career spans. We examine how exposure to industrial robots, information and communication technology (ICT), and artificial intelligence (AI) relate to retirement expectations among workers in 20 European countries. To this end, we link individual-level data from the European Working Conditions Survey (2005–2024) with lagged technology-exposure measures. Technology exposure shows little systematic association with preferred retirement timing. Nevertheless, robots and especially AI are linked to the perception of being able to work until age 60. These associations vary across workers and tasks, suggesting that job design and worker adaptation determine whether technology supports longer working lives. |
| Keywords: | retirement, expectations, technological change, robots, ICT, AI |
| JEL: | I31 J26 O33 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18938 |
| By: | Itzik Fadlon; Tal Gross; Alex Hoagland; Timothy Layton |
| Abstract: | We study the value of informal care from a spouse and how access to such care shapes optimal insurance coverage for long-term care. Using Medicare claims and a novel spousal crosswalk, we examine how the sudden incapacitation of a spouse affects their partner's use of formal care. A spouse's health shock increases their partner's probability of a nursing-home stay by 30%. We document significant negative health effects for the partner, but provide evidence that their increase in nursing-home stays is largely driven by substitution from informal care to formal care. When their partners are incapacitated, Medicare recipients become less sensitive to the price of formal care, consistent with a higher valuation of that care and reduced moral hazard. We develop a framework to interpret these findings. The framework translates differences in the level and price elasticity of demand for formal care into a lower-bound estimate of the value of informal care provided by a spouse. It also suggests that optimal insurance for long-term care should be designed at the household level with more generous coverage for those who do not have access to informal care. |
| JEL: | I13 I18 J12 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35784 |
| By: | Concetta Rondinelli (Bank of Italy); Federico Tullio (Bank of Italy); Francesca Zanichelli (Bank of Italy) |
| Abstract: | This paper analyses the extent to which demographic changes have affected household consumption behaviour over the period 1997-2023. Using microdata from the Italian Household Budget Survey (HBS), we show that average household expenditure in real terms declined significantly over the last twenty-five years. Changes in population structure contributed to this trend: population ageing had only a limited impact, whereas the decline in average household size and in the share of couples with children played an important role. These changes, on the other hand, mitigated the decline in per-capita consumption and had only a negligible effect on equivalised consumption. The composition of household expenditure remained broadly stable over time for most expenditure categories. By contrast, the share allocated to housing and utilities increased substantially, mainly reflecting relative price dynamics and, to a lesser extent, the rising prevalence of single-person households. |
| Keywords: | consumption pattern, demographics, Covid-19 |
| JEL: | D12 C52 J11 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:bdi:opques:qef_1033_26 |
| By: | Hiroyuki Yamada (Keio University); Atsushi Nakagomi (Chiba University); Takahiro Tabuchi (Tohoku University) |
| Abstract: | Japan has the lowest rate of generative AI use among major economies, yet little is known about how the technology has spread within the country. This study uses the sixth wave of the Japan COVID-19 and Society Internet Survey (JACSIS, N = 27, 630), which asks respondents when they first started using generative AI, to reconstruct cumulative adoption curves for Japanese municipalities from November 2022 to January 2026. Because every respondent became able to adopt at the same moment, the release of ChatGPT, the retrospective cohorts support a discrete-time hazard analysis without left truncation. Linking postal codes to municipal statistics, we document four findings. First, adoption follows the urban hierarchy: by January 2026, 50% of residents of the quintile of municipalities with the highest population density had adopted, compared with 35% in the quintile with the lowest population density, and the ratio between the two rose from 0.55 to 0.71 over the four periods, indicating relative convergence alongside a widening absolute gap. Second, most of the geographic gradient reflects who lives where rather than where they live: individual characteristics explain 64% of the population-density coefficient, and the coefficients on population density and on distance to Tokyo become statistically indistinguishable from zero once individual controls are included. Third, municipal population aging is negatively associated with adoption beyond its compositional effect, but only in the first two years of diffusion. Fourth, the job openings-to-applicants ratio in the respondent's workplace area is positively associated with work-related adoption and unrelated to purely private adoption, a pattern consistent with labor scarcity pulling generative AI into workplaces. The association is statistically significant but economically small: a one-point increase in the ratio is associated with a work-adoption probability less than one percentage point higher. Regional differences are concentrated in whether people adopt, not in how intensively adopters use the technology or whether they stop using it: one in six ever-users has lapsed, and lapsing follows age, education, and job content rather than place. The results are correlational, but they suggest that Japan's low national adoption rate is a consequence of its demographic and occupational composition rather than of a distinct rural disadvantage. |
| Keywords: | Generative AI, technology diffusion, regional inequality, population aging, labor shortage, Japan |
| JEL: | O33 R12 J11 J23 L86 |
| Date: | 2026–09–15 |
| URL: | https://d.repec.org/n?u=RePEc:keo:dpaper:dp2026-020 |
| By: | Falkenbach, Michelle; Joachim, Maria; Wismar, Matthias; Williams, Gemma A.; Correia, Tiago; Czabanowska, Katarzyna; Ungureanu, Marius Ionuț; Zapata, Tomas; Marchandise, Charlotte; Margheri, Federica; Kuhlmann, Ellen |
| Abstract: | Health systems across Europe are transforming service delivery in response to population ageing, multimorbidity, workforce shortages, and fiscal constraints. New models of care, including integrated care, multidisciplinary teams, expanded scopes of practice, community-based services, and digitally enabled care, depend on a health and care workforce (HCWF) that is sufficiently staffed, appropriately skilled, and supported to adapt to changing roles and responsibilities. Yet implementation continues to lag behind policy ambitions. This commentary argues that the principal HCWF challenge is no longer a lack of evidence. Extensive research has identified workforce shortages, retention problems, staffing challenges, skills needs, and planning deficiencies, while numerous policy solutions have been proposed. Rather, the challenge is one of implementation. We argue that leadership for implementation is a critical but underdeveloped dimension of HCWF policy. Leadership is required at three interconnected levels: political leadership to create the conditions for reform, intersectoral leadership to align actors across complex governance systems, and organizational leadership to translate policy into improved workforce experiences, clinical working conditions, and patient outcomes. If the next decade of HCWF policy is to look different from the last, greater attention must be paid not only to what should be done, but also to who will champion reform and lead implementation and how leadership capacity can be developed across health systems. |
| Keywords: | health and care workforce;health system transformation;health workforce policy;implementation;leadership |
| JEL: | R14 J01 |
| Date: | 2026–09–11 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:141080 |
| By: | Jesús Fernández-Villaverde; Patrick Norrick |
| Abstract: | As of 2026, humanity is likely below replacement fertility. That has never happened before, not in wars or pandemics. But the real surprise is that the fall has been concentrated in low- and middle-income countries and among poorer and less educated women. We fit a single-factor model to 236 countries since 1950: the common component peaked in 1978, and what drives fertility down today are country-specific trends, 219 of them negative and not one leveling off. None of the commonly cited mechanisms can account for this pattern, so we offer a conjecture: modernity itself, which makes a third child expensive and childlessness cheap. Children come in integers, so it takes very little to move a cohort’s fertility rate from 1.8 to 1.3. And nothing in an economy pushes fertility back to 2.1. We close with the main economic consequences, in particular slow growth. |
| Keywords: | fertility decline, demographic transition, population aging, economic growth, labor force, population projections |
| JEL: | J11 J13 O40 E24 O11 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12997 |
| By: | Luca Casolaro (Bank of Italy); Claudio Luccioletti (Bank of Italy); Andrea Neri (Bank of Italy) |
| Abstract: | The paper analyses the relationship between demographic trends and housing prices in Italy at the municipal level over the period 2010-2025. It aims to assess the extent to which population changes are associated with housing prices and whether this relationship emerges primarily in the short or long term. The analysis also considers potential local heterogeneity, distinguishing between remote areas (aree interne) and more accessible areas (aree non interne), as well as across the country's macro-regions. |
| Keywords: | housing prices, demographic trends, remote areas, panel data |
| JEL: | R31 J11 C23 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:bdi:opques:qef_1043_26 |