OF MEDICAL EXPENSESdenardim/research/SLIDDec09.pdf · Medical expenses rise quickly with age and...
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WHY DO THE ELDERLY SAVE? THE ROLE
OF MEDICAL EXPENSES
Mariacristina De NardiFederal Reserve Bank of Chicago and NBER
Eric FrenchFederal Reserve Bank of Chicago
John Bailey JonesUniversity at Albany, SUNY
December 2009
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Overview
What do we do?Estimate a structural model of savingsafter retirement allowing for heterogeneity in:
medical expenseslife expectancy
What are we trying to understand? The saving of theelderly:
Many elderly individuals keep lots of assets.High income individuals deplete their assets moreslowly than low income individuals.
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Figure 1: AHEAD data (unbalanced panel)
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Figure 2: AHEAD data (unbalanced panel)
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Why our model?
Data show considerable heterogeneity inlife expectancymedical expenses
By:agegenderpermanent incomehealth
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Heterogeneity implications
For saving behaviorDifferential mortality⇒ heterogenous saving rates,with high PI people and women saving more.Medical expenses rise quickly with age⇒ keep assetsfor old age.Medical expenses rising with PI⇒ high PI people saveat higher rate.
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Heterogeneity implications: continued
For observed sample:mortality biasSample composition changes: High PI people andwomen live longer
+ →In an unbalanced panel, this causes observed assets toincreasewith age
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How we do it
First step: estimate mortality and medical expenses as afunction of age, gender, health and permanent income.
Second step: use first step results to estimate our modelwith method of simulated moments.
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Contributions
Estimate medical expenses using better data and moreflexible functional forms.
Medical expenses rise quickly with age and PI.
Estimate mortality probabilities by age, gender, permanentincome, and health.
Variation is large.
Find that medical expenses and social insurance areimportant in understanding the elderly’s savings.
Results are robust to:including a bequest motivemaking medical expenditures endogenous
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Related literature (subset)
Hubbard et al. (1994, 1995), Palumbo (1999)
Scholz et al. (2006)
Hurd (1989); De Nardi (2004); Kopczuc and Lupton(2007); Dynan et al. (2002); Ameriks et al. (2009).
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Model
Singles only,abstract from spousal survival.
Householdsmaximize total expected lifetime utility.
Flow utility from consumption (CRRA). Utility can varywith health.
Rational expectations.Beliefs about mortality rates, healthcost distribution, etc., are estimated from the data.
Bequest motive.Functional form follows De Nardi (2004):bequests are a luxury good.
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Income
yt = y(g, h, I, t),
g = gender,h = health,I = permanent income.
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Uncertainty
Health status: age-, gender- andpermanent-income-specific Markov chain.
Survival: function of gender, age, health status, andpermanent income.
Medical expenses:
ln(mt) = m(g, ht, I, t) + σ(g, ht, I, t)ψt,
ψt = ζt + ξt,
ζt = AR(1) shock,ξt = white noise shock.
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Constraints
Budget constraint:
at+1 = at + yn(rat + yt, τ) + bt −mt − ct.
yn(.) = post-tax income;yt = “non-interest” income;τ = tax parameters;bt = government transfers;mt = medical expenses.
Transfers support a consumption floor:
bt = max{0, cmin +mt − [at + yn(rat + yt), τ)]}.
Borrowing constraint:
at+1 ≥ 0.
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Constraints in terms of cash-on-hand
Budget constraint:
at+1 = at + yn(rat + yt, τ) + bt −mt − ct
= xt − ct.
Transfers support a consumption floor:
xt ≥ cmin.
Borrowing constraint:
ct ≤ xt.
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Recursive formulation
Vt(xt, g, I, ht, ζt) = maxct,xt+1
{
[1 + δht]c1−νt
1 − ν
+ βsg,h,I,tEt
(
Vt+1(xt+1, g, I, ht+1, ζt+1))
+ β(1 − sg,h,I,t)θ(xt − ct + k)
1 − ν
(1−ν)}
xt = cash-on-hand
g = gender; I = permanent income
ht = health status (0 ⇒ bad,1 ⇒ good)
ζt = persistent health cost shock
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Constraints in Detail
xt+1 = max{xt − ct + y(
r(xt − ct) + yt+1, τ)
−mt+1, cmin},
yt+1 = y(g, h, I, t+ 1),
xt ≥ cmin,
ct ≤ xt,
ln(mt+1) = hc(g, ht+1, t+ 1, I) + σ(g, ht+1, I, t+ 1)ψt+1,
ψt+1 = ζt+1 + ξt+1.
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Method of simulated moments
Match median assets by permanent income quintile, cohortand age.
101 moment conditions.
Correct for cohort effects by using cohort-specific momentsand initial conditions.
Correct for mortality bias (rich people live longer) byallowing mortality rates to depend on permanent incomeand gender.
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AHEAD data
Household heads aged 70 or older in 1993/4
Consider only the retired singles
Follow-up interviews in 1995/6, 1998, 2000, 2002, 2004,2006
Asset data begins in 1996 (1994 asset data faulty), uses2,688 individuals
Use full, unbalanced panel
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Results from first step estimation
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Figure 3: Average income, AHEAD data
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Figure 4: Average medical expenses, AHEAD data
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Income Healthy Unhealthy Healthy UnhealthyQuintile Male Male Female Female All
bottom 7.6 5.9 12.8 10.9 11.1second 8.4 6.6 13.8 12.0 12.4third 9.3 7.4 14.7 13.2 13.1fourth 10.5 8.4 15.7 14.2 14.4top 11.3 9.3 16.7 15.1 14.7
Men 9.7Women 14.3
Healthy 14.4Unhealthy 11.6
Table 1: Life expectancy at age 70
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Results from second step estimation
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Benchmark Health Bequests AllParameter (1) (2) (3) (4)
ν: coeff. relative risk aversion 3.81 3.75 3.84 3.66(0.50) (0.47) (0.55) (0.55)
β: discount factor 0.97 0.97 0.97 0.97(0.04) (0.05) (0.05) (0.04)
δ: pref. shifter, good health 0.0 -0.21 0.0 -0.36NA (0.18) NA (0.14)
cmin: consumption floor 2,663 2,653 2,665 2,653(346) (337) (353) (337)
θ: bequest intensity 0.0 0.0 2,360 2,419NA NA (8,122) (1,886)
k: bequest curvature (in 000s) NA NA 273 215NA NA (446) (150)
Overidentification statistic 82.3 80.6 81.5 77.5P-value 87.4% 88.5% 85.4% 90.5%
Table 2: Estimated Structural ParametersWhy do the Elderly Save? Sept. 2009 – p. 25/46
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Figure 5: Median assets by cohort and PI quintile: data and bench-
mark model
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Mortality bias
Figure 6: Left panel→ AHEAD data; right panel→ benchmark
model
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Bequests
Bequest motives are large for the richest people, but veryimprecisely estimated.
They do not improve the model’s fit.They do not not change other parameters.
This doesnot mean bequests are unimportant:
The estimated bequest motive implies that the richbequeath 88 cents of every dollar.Our data set does not contain many rich people.
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Distribution of bequests: data and model0
.1.2
.3.4
.5.6
.7.8
.91
10000 30000 100000 300000 1000000value of assets
prob
abili
ty
Bequest Motive
0.1
.2.3
.4.5
.6.7
.8.9
1
10000 30000 100000 300000 1000000value of assets
prob
abili
ty
No Bequest Motive
Figure 7: Cumulative distribution function of assets held 1 period
before death. Left, model with bequest motives. Right:
model without. Solid line: model, lighter line: data.
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Experiments
Fix preference parameters at baseline estimates, vary otherparameters.
Eliminating out-of-pocket medical expenditures has a bigeffect on savings.
Eliminating medical expense risk has a small effect.
Lowering the consumption floor by 20% has a big effect onsavings, even for the rich.
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Figure 8: Benchmark and model with no medical expenditures
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Figure 9: Benchmark and model with no medical expense risk
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Figure 10: Benchmark and model with the consumption floor re-
duced by 20%
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Making medical expenditures endogenous
Retirees receive utility from medical goods.
Medical expenses do not affect health and/or survival:RAND experiment (Brook et al., 1983); Fisher et al. (2003);Finkelstein and McKnight (2005); Khwaja (2009).
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Endogenous medical expenditure model
Flow utility:
u(ct,mt, ht, ζt, ξt, t) =1
1 − νc1−νt +µ(t, ht, ζt, ξt)
1
1 − ωm1−ω
t ,
µ(·) : medical “preference shifter”mt : total medical expendituresq(t, ht)mt : out-of-pocket medical expenditures
Transfers: set to guarantee a minimum level of utility, andthus depend onµ(·):
b(t, at, g, ht, I, ζt, ξt) = max{0, b∗(t, at, g, ht, I, ζt, ξt)}.
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Expanded estimation
In addition to matching asset profiles, we now match:
mean and90th percentile of medical spending,conditional on age and permanent income
1st and2nd autocorrelations of logged medical spending
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Results for endogenous expenditure model
Estimated parameters:ν = 2.15; ω = 3.19; β = 0.99.
Model does a reasonable job of fitting the asset data.
Model fits the medical expenditure data better than baselinemodel.
Medical spending is still important: Eliminatingout-of-pocket medical expenditures still has a big effect onsavings.
The effect of reducing the consumption floor is smaller thanbefore, but still important at all income levels.
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Figure 11: Benchmark and model with no medical expenditures
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Effects of reducing the consumption floor
Figure 12: Median assets: baseline and model with 50% of the con-
sumption floor for the exogenous (left panel) and en-
dogenous (right panel) medical expense models.
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Conclusions
Model fits data well with reasonable preference parametervalues.
Key elements include:heterogeneous lifespansmedical expenses that rise with age and PIconsumption floor
Results are robust to:including a bequest motivemaking medical expenditures endogenous
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Income Healthy Unhealthy Healthy UnhealthyQuintile Male Male Female Female All
Percentage living to age 85bottom 10.1 6.9 35.7 28.6 28.8second 13.7 9.3 41.1 34.1 35.3third 17.8 12.3 46.4 40.2 38.9fourth 23.3 16.6 51.7 45.5 45.2top 27.8 21.2 57.1 49.9 46.5
Percentage living to age 95bottom 0.6 0.4 6.3 5.1 5.0second 0.9 0.6 7.9 6.7 6.7third 1.3 0.9 9.6 8.4 7.8fourth 2.0 1.4 11.6 10.2 9.5top 2.6 2.0 13.8 11.8 10.0
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Method of simulated moments: details
Consider householdi of birth cohortc in calendar yeart,belonging to theqth permanent income quintile.
Let aqct denote the model-predicted median asset level.
Moment condition for GMM criterion function:
E(
I{ait ≤ aqct} − 1/2 | q, c, t,hh i alive att)
= 0.
Convert into an unconditional moment:
E(
[
I{ait ≤ aqct} − 1/2]
× I{qi = q} × I{ci = c}
× I{hh i alive att}∣
∣ t)
= 0.
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Figure 13: Median consumption by cohort and PI quintile: bench-
mark model
Why do the Elderly Save? Sept. 2009 – p. 43/46
![Page 44: OF MEDICAL EXPENSESdenardim/research/SLIDDec09.pdf · Medical expenses rise quickly with age and PI. Estimate mortality probabilities by age, gender, permanent income, and health.](https://reader033.fdocuments.in/reader033/viewer/2022050104/5f42f9fae384496084028cdc/html5/thumbnails/44.jpg)
Endogenous medex: recursive formulation
V (t, at, g,ht, I, ζt, ξt) = maxct,mt,at+1
{
c1−νt
1 − ν+ µ(t, ht, ζt, ξt)
m1−ωt
1 − ω
+ βsg,h,I,tEt
(
V (t+ 1, at+1, g, ht+1, I, ζt+1, ξt+1))
}
,
subject to:
at+1 = at + yn(rat + yt) + b(t, at, g, ht, I, ζt, ξt)
− ct −mtq(t, ht),
and other constraints.
Why do the Elderly Save? Sept. 2009 – p. 44/46
![Page 45: OF MEDICAL EXPENSESdenardim/research/SLIDDec09.pdf · Medical expenses rise quickly with age and PI. Estimate mortality probabilities by age, gender, permanent income, and health.](https://reader033.fdocuments.in/reader033/viewer/2022050104/5f42f9fae384496084028cdc/html5/thumbnails/45.jpg)
Figure 14: Median assets by cohort and PI quintile: data and model
with endogenous medical expenditures
Why do the Elderly Save? Sept. 2009 – p. 45/46