The risk protection and redistribution effects of long-term care co-payments

Abstract

Co-payments for long-term care (LTC) can impose a substantial financial burden on the elderly. How this burden is distributed across income groups depends on the design of the co-payment. We estimate the lifecycle dynamics of LTC using Dutch administrative data. These estimates are inputs in a stochastic lifecycle decision model. Using the model, we analyze the welfare effects of the Dutch income- and wealth-dependent co-payment system and compare it to alternative systems. We find that the Dutch co-payment system redistributes income to low-income groups, who use the most care over their life but contribute the least co-payments, from high-income groups, who pay the most. Moreover, the Dutch system protects the middle-income groups relatively well against financial risk: although alternative co-payment systems hardly affect these groups average payments, they induce welfare losses of 2% to 4% due to an increased risk of very high co-payments.