Long-Term Care Insurance: Partnership or Crowding Out?

  • Joan Costa-Font
  • Christophe Courbage


The design of long-term care1 (LTC) financing schemes is slowing down the transformation of protection and insurance structures that address the problems of old-age care. Most of these are not new, but highly entrenched in the organization of modern society and in State intervention in the area of welfare. However, to date there are good reasons to believe that demand triggers are markedly exacerbated by the rapid ageing of the European populations together with the transformation of family structures, and its associated norms that impinge effects on caregiving duties. The latter encompasses the redefinition of traditional intergenerational contracts in place to provide ‘support for care’. However, the expansion of public insurance alone, the solution that was prevalent in the times of the so-called ‘golden age of the welfare State’, is not viable any more today. Indeed, public schemes face significant constraints to the expansion of welfare services that are not always perceived as welfare-improving. Similarly, current pressures to cut down excessive public expenditure do nothing but exacerbate the already tight constraints to the expansion of public insurance. On the other hand, the solution of pre-welfare State times, based on family caregiving, is not a satisfactory arrangement given the constraints of modern life unless it is complemented by State and market alternatives.


Private Insurance Informal Care Moral Hazard Informal Caregiver Cost Sharing 
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  1. Baltensperger, E., Buomberger, A., Luppa, A., Keller, B. and Wicki, A. (2008) ‘Regulation and Intervention in the Insurance Industry — Fundamental Issues’, The Geneva Reports, No.1.Google Scholar
  2. Barr, N. (2004) Economics of the Welfare State (Oxford: Oxford University Press).Google Scholar
  3. Brown, J.R. and Finkelstein, A. (2007) ‘Why is the Market for Long-term Care Insurance So Small?’, Journal of Public Economics, 91, pp. 1967–1991.CrossRefGoogle Scholar
  4. Brown, J.R. and Finkelstein, A. (2008) ‘The Interaction of Public and Private Insurance: Medicaid and the Long-term Insurance Market’, American Economic Review, 98 (3), pp. 1083–1102.CrossRefGoogle Scholar
  5. Brown, J.R. and Finkelstein, A. (2009) ‘The Private Market for Long Term Care Insurance in the United States: A Review of the Evidence’, The Journal of Risk and Insurance, 76, pp. 5–29.CrossRefGoogle Scholar
  6. Costa-Font, J. (2010) ‘Family Ties and the Crowding Out of Long Term Care Insurance,’ Oxford Review of Economic Policy, 26 (4), pp. 691–712.CrossRefGoogle Scholar
  7. Durand, R. and Taleyson, L. (2003) ‘Les raisons du succès de l’assurance dépendance en France’, Risques — Les Cahiers de l’Assurance, 55, pp. 115–120.Google Scholar
  8. Eurobarometer (2007) Special EUROBAROMETER 283, Brussels.Google Scholar
  9. Kessler, D. (2010) ‘Confronting the Challenge of Long-term Care in Europe’, CESifo DICE Report, No. 2, pp. 18–23.Google Scholar
  10. Kunreuther, H. (1978) Disaster Insurance Protection: Public Policy Lessons (New York: Wiley).Google Scholar
  11. Mayhew, L., Karlsson, M. and Rickayzen, B. (2010) ‘The Role of Private Finance in Paying for Long Term Care’, Economic Journal, 120, pp. F478–F504.CrossRefGoogle Scholar
  12. OECD (2004) Private Health Insurance in OECD Countries (Paris: OECD).CrossRefGoogle Scholar
  13. OECD (2005) Long-term Care for Older People (Paris: OECD).CrossRefGoogle Scholar
  14. Pauly, M.V. (1990) ‘The Rational Nonpurchase of Long-term Care Insurance’, Journal of Political Economy, 98, pp. 153–168.CrossRefGoogle Scholar
  15. Rosso-Debord, V. (2010) Rapport d’information sur la prise en charge des personnes âgées dépendantes, Rapport de l’Assemblée Nationale (Paris: Assemblée Nationale).Google Scholar

Copyright information

© Joan Costa-Font and Christophe Courbage 2012

Authors and Affiliations

  • Joan Costa-Font
    • 1
  • Christophe Courbage
    • 2
  1. 1.London School of Economics and Political ScienceUK
  2. 2.The Geneva AssociationSwitzerland

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