Three essays on the economic decisions faced by elderly households

TitleThree essays on the economic decisions faced by elderly households
Publication TypeThesis
Year of Publication2010
AuthorsSun, W
Academic DepartmentEconomics
DegreeDoctor of Philosophy
UniversityBoston College
CityBoston, MA
Thesis Type3397559
KeywordsHealthcare, Methodology

This dissertation contains three essays. Each considers an economic decision faced by elderly households. The cost of nursing home care represents a substantial financial risk for older households. Yet, only 10 percent purchase long-term care insurance (LTCI), with many relying on Medicaid. The first essay estimates a structural model of the LTCI purchase decision using Health and Retirement Study data. Estimates indicate that this population has a modest preference for higher quality care and thus Medicaid crowds out LTCI. In addition, housing wealth provides self-insurance against the cost of nursing home care, so that individuals who are "house-rich cash-poor" are less likely to purchase LTCI. I also evaluate public policies designed to stimulate the take-up of LTCI and reduce Medicaid spending. I find that a comprehensive 20 percent subsidy would increase take-up by 160 percent, but the resulting Medicaid savings would amount to only 22 percent of the subsidy cost. A targeted subsidy would be more likely to break even, but would have only a small effect on coverage. Full enforcement of Medicaid estate recovery programs would reduce Medicaid expenditure by 31 percent, but would have insignificant effect on LTCI coverage. The second essay investigates the impact of house prices fluctuations on the non-durable goods consumption decision of older households. House prices in the United States fluctuate over time with significant regional variation. Thus, understanding how these price movements affect households' consumption has important policy implications. Existing studies focus mostly on the working population, leaving the effect of older households, who could be either the largest beneficiaries or victims of house price fluctuations, unexamined. Using Health and Retirement Study data, I show that house price fluctuations significantly affect non-durable goods consumption of older households. Estimates indicate that both the wealth effect and a relaxed borrowing constraint increase consumption when house prices appreciate. In addition, I find that only unexpected changes in house prices lead to changes in consumption of non-credit constrained households, which is consistent with economic theory predictions. Finally, I provide evidence that older households usually fund the additional consumption by increasing mortgage debt, rather than by drawing down financial assets. The third essay evaluates the value of the additional longevity insurance acquired by delaying claiming social security benefit. Individuals can claim Social Security at any age from 62 to 70, although most claim at 62 or soon thereafter. Those who delay claiming receive increases that are approximately actuarially fair. I show that expected present value calculations substantially understate both the optimal claim age and the losses resulting from early claiming because they ignore the value of the additional longevity insurance acquired as a result of delay. Using numerical optimization techniques, I illustrate that for plausible preference parameters, the optimal age for non-liquidity constrained single individuals and married men to claim benefit is between 67 and 70. I calculate that Social Security Equivalent Income, the amount by which benefits payable at suboptimal ages must be increased so that a household is indifferent between claiming at those ages and the optimal combination of ages, can be as high as 19 percent.

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