Research
Nursing Homes in Equilibrium: Implications for Long-term Care Policies
Joint with Minjoon Lee
Abstract:
We build an equilibrium model of a nursing home market with decision-makers on both sides of the market. On the demand side, heterogeneous households with stochastic needs for long-term care solve dynamic optimization problems, choosing between in-home and nursing home care as well as the number of care hours if using in-home care. On the supply side, locally competitive nursing homes decide prices and intensities of care given the household demand. Medicaid provides long-term care
to the poorest, but allocating care not based on prices also causes inefficiency. We use our equilibrium model to examine the impacts of various long-term care policies. We find that a lump-sum subsidy to the out-of-pocket cost of in-home care significantly increases households’ welfare without a large increase in government expenditure because the policy diverts individuals away from Medicaid-paid care. We show that equilibrium analysis is important for assessing welfare and distributional effects of policies.
Old, frail, and uninsured: Accounting for features of the
U.S. long-term care insurance market. Econometrica,vol. 87 (2019), pp: 981-1019
Joint with R. Anton Braun and Karen Kopecky
Online Appendix
Abstract:
Half of U.S. 50-year-olds will experience a nursing home stay before
they die, and one in ten will incur out-of-pocket long-term care
expenses in excess of $200,000. Surprisingly, only about 10% of
individuals over age 62 have private long-term care insurance (LTCI)
and LTCI takeup rates are low at all wealth levels. We analyze the
contributions of Medicaid, administrative costs, and asymmetric
information about nursing home entry risk to low LTCI takeup rates
in a quantitative equilibrium contracting model. As in practice, the insurer
in the model assigns individuals to risk groups based on noisy indicators of their nursing home entry risk.
All individuals in frail and/or low income risk groups are denied coverage because the cost of insuring any
individual in these groups exceeds that individual's willingness-to-pay.
Individuals in insurable risk groups are offered a menu of contracts whose terms vary across risk groups.
We find that Medicaid accounts for low LTCI takeup rates of poorer
individuals. However, administrative costs and adverse selection are
responsible for low takeup rates of the rich. The model reproduces
other empirical features of the LTCI market including the fact that
owners of LTCI have about the same nursing home entry rates as non-owners.
Old, Sick, Alone, and Poor: A Welfare Analysis of Old-Age Social Insurance Programs, Review of Economic Studies 84 (2017), pp.580-612.
Joint with R. Anton Braun and Karen Kopecky
Abstract:
All individuals face some risk of ending up old, sick, alone and poor. Is there a role for social insurance for these risks and if so what is a good program? A large literature has analyzed the costs and benefits of pay-as-you-go public pensions and found that the costs exceed the benefits. This paper, instead, considers means-tested social insurance programs for retirees such as Medicaid and food stamp programs. We find that the welfare gains from these programs are large. Moreover, the current scale of means-tested social insurance in the U.S. is too small in the following sense. If we condition on the current Social Security program, increasing the scale of means-tested social insurance by 1/3 benefits both the poor and the affluent when a payroll tax is used to fund the increase.
The Impact of Medical and Nursing Home Expenses on Savings, American Economic Journal: Macroeconomics, v. 6, July 2014, pp: 29-72.
previously circulated under title "The Impact of Medical and Nursing Home Expenses and Social Insurance Policies on Savings and Welfare."
Joint with Karen Kopecky
Abstract:
We consider a life-cycle model with idiosyncratic risk in earnings, out-of-pocket medical and nursing home expenses, and survival. Partial insurance is available through welfare, Medicaid, and social security. Calibrating the model to the US we show that (1) savings for old-age, out-of-pocket expenses account for 13.5 percent of aggregate wealth, half of which is due to nursing home expenses; (2) cross-sectional out-of-pocket nursing home risk accounts for 3 percent of aggregate wealth and substantially slows down wealth decumulation at older ages; (3) the impact of medical and nursing home expenses on private savings varies significantly across the lifetime earnings distribution; and (4) all newborns would benefit if social insurance for nursing home stays was made more generous.
How Important Is Human Capital? A Quantitative Theory Assessment of World Income Inequality,
Review of Economic Studies, Vol. 77(4), October 2010, pp: 1421-1449
Joint with Andrés Erosa and Diego Restuccia
Abstract: We build a model of heterogeneous individuals—who make investments in schooling quantity and quality—to quantify the importance of differences in human capital vs. total factor productivity (TFP) in explaining the variation in per capita income across countries. The production of human capital requires expenditures and time inputs; the relative importance of these inputs determines the predictions of the theory for inequality both within and across countries. We discipline our quantitative assessment with a calibration firmly grounded on US micro evidence. Since in our calibrated model economy human capital production requires a significant amount of expenditures, TFP changes affect disproportionately the benefits and costs of human capital accumulation. Our main finding is that human capital accumulation strongly amplifies TFP differences across countries: to explain a 20-fold difference in the output per worker, the model requires a 5-fold difference in the TFP of the tradable sector, vs. an 18-fold difference if human capital is fixed across countries.
Progressive Taxation in a Dynastic Model of Human Capital, Journal of Monetary Economics, Vol. 54(3), April 2007, pp: 667-685
Joint with Andrés Erosa
Abstract:
We develop a quantitative theory of economic inequality to investigate the effects of replacing the current U.S. progressive income tax system with a proportional one. The cross-sectional implications of the theory are used to discipline the assessment of the effects of tax policy and circumvent the lack of conclusive micro-evidence on the parameterization of the human capital production technology. We find that the elimination of progressive taxation increases steady state level of output by 12.6%, capital by 21.8%, and consumption by 13.2%. Moreover, it increases economic inequality and its persistence across generations.
A Quantitative Analysis of Inflation as a Tax on the Underground Economy, Journal of Monetary Economics, Vol. 53(4), May 2006, pp: 773-796
Abstract:
Inflation rates are more dispersed and are persistently higher in developing countries. This paper quantifies the importance of the public-finance motive for inflation in the presence of a tax-evading sector, the underground economy. The approach is motivated by the observation that the underground economy is especially large in poor countries. The analysis builds on a general equilibrium monetary model with two production sectors, where income in one of the sectors cannot be taxed. A benevolent government finances its budget using an optimal combination of the income tax rate and the inflation rate. The model is first calibrated to the U.S. economy and is then used for a cross-country simulation. The resulting relationships between the size of an underground economy, inflation rate, income tax rate and the share of seigniorage in the government revenue rationalize the cross-country data quantitatively well.
