Fuino Michel, Rudnytskyi Iegor, Wagner Joël
Department of Actuarial Science, University of Lausanne, Quartier Chamberonne - Extranef, 1015 Lausanne, Switzerland.
Swiss Finance Institute, University of Lausanne, Lausanne, Switzerland.
Eur Actuar J. 2020;10(2):557-597. doi: 10.1007/s13385-020-00242-1. Epub 2020 Jul 16.
The increase in the proportion of elderly people in most industrialized countries triggers higher demand for long-term care (LTC) associated with limitations in activities of daily living (ADL). The aim of this research is to derive the drivers affecting the probability of reporting limitations in ADL and the probability of demanding formal LTC, e.g., personal care and services in domestic tasks. By using the most recent wave of a cross-national European survey on individuals aged over 50 years (SHARE, wave 6), we develop econometric models for identifying the effect of demographic, social and medical factors on ADL limitations and formal LTC along five conjectures. On the one hand, we analyze functional limitations and we find that characteristics such as the age, the gender, the wealth status and the education level influence the probability to report limitations. Further, while we find that pathologies significantly increase the probability to become dependent in general, the effect of cancer is lower. On the other hand, we find again an influence of the demographic and social factors on the probability to use formal LTC. We emphasize on the decrease in the probability due to the presence of the partner in the household, in particular for housekeeping tasks. This is less the case for help related with personal care. In addition, we note that pathologies such as cancer have no influence on the probability to report formal LTC while others like mental and Parkinson diseases highly increase it. We find that elderly living in countries with LTC family care schemes report less formal care than in others. This indicates the importance of LTC policies. Finally, we validate the robustness of our results by applying the models to data from earlier waves of the survey. Our findings give insights for the underwriting standards to be used in future LTC insurance products and for the design of LTC policy environments across Europe.
大多数工业化国家老年人口比例的增加引发了对与日常生活活动（ADL）受限相关的长期护理（LTC）的更高需求。本研究的目的是找出影响报告ADL受限可能性以及要求获得正式LTC（例如个人护理和家务服务）可能性的驱动因素。通过使用最新一轮针对50岁以上个人的欧洲跨国调查（SHARE，第6波），我们沿着五个推测构建了计量经济学模型，以确定人口、社会和医疗因素对ADL受限和正式LTC的影响。一方面，我们分析功能受限情况，发现年龄、性别、财富状况和教育水平等特征会影响报告受限的可能性。此外，虽然我们发现疾病总体上会显著增加依赖的可能性，但癌症的影响较小。另一方面，我们再次发现人口和社会因素对使用正式LTC的可能性有影响。我们强调由于家庭中有伴侣，使用正式LTC的可能性会降低，特别是在家务方面。在个人护理相关帮助方面情况则并非如此。此外，我们注意到癌症等疾病对报告正式LTC的可能性没有影响，而精神疾病和帕金森病等其他疾病则会大幅增加这种可能性。我们发现生活在有LTC家庭护理计划国家的老年人报告的正式护理比其他国家少。这表明了LTC政策的重要性。最后，我们通过将模型应用于调查早期波次的数据来验证结果的稳健性。我们的研究结果为未来LTC保险产品的承保标准以及欧洲LTC政策环境的设计提供了见解。
