Flexible and affordable methods of paying for long-term care insurance. (English) Zbl 1461.91253

Summary: With the expected dramatic increase in the number of older people requiring care, and the tightening of public funding, individuals will be increasingly expected to contribute to, and plan for, their own care in later life. However, history shows us that people are very reluctant to save for their care to the extent that there are no longer any providers of traditional prefunded long-term care insurance products in the United Kingdom to help address this problem. In this article, we consider a a disability-linked annuity that provides benefit payments toward the cost of both domiciliary and residential nursing care. We investigate different ways in which individuals can purchase this product with the goal of minimizing the impact on their living standards, hence making the purchase of the product more palatable. In addition to the traditional methods of purchasing insurance out of income and savings, we show that this product can also be purchased by making use of assets such as residential property. This flexibility would allow individuals to have control over the timing of their payments to fit around their lifestyle, particularly for those with low retirement incomes. It follows that some people will be more attracted to particular payment methods than others, and a framework is presented that segments people according to individual circumstances. A model is developed showing how the annuity works and how premiums are calculated.


91G05 Actuarial mathematics
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[1] Long term care (2017)
[2] Appleby, J., Spending on health and social care over the next 50 years: Why think long term?, The Kings Fund (2013)
[3] Brown, J.; Warshawsky., M., The life care annuity: A new empirical examination of an insurance innovation that addresses problems in the markets for life annuities and long‐term care insurance, Journal of Risk and Insurance, 80, 3, 677-703 (2013)
[4] Colombo, F.; Llena-Nozal, A.; Mercier, J.; Tjadens., F., Health wanted? Providing and paying for long-term care (2011), OECD: OECD, Paris
[5] Dilnot, A., Fairer care funding: The report of the Commission on Funding of Care and Support (2011)
[6] Engelhardt, G. V.; Kumar., A., Pensions and household wealth accumulation, Journal of Human Resources, 46, 1, 203-36 (2011)
[7] Forder, J.; Fernandez., J.-L., PSSRU Discussion Paper 2769, Length of stay in care home report. Commissioned by BUPA Care Services (2011), Canterbury, UK: PSSRU, Canterbury, UK
[8] Guzman-Castillo, M.; Ahmadi-Abhari, S.; Bandosz, P.; Capewell, S.; Steptoe, A.; Singh-Manoux, A.; Kivimaki, M.; Shipley, M.; Brunner, E.; O’Flaherty., M., Forecasted trends in disability and life expectancy in England and Wales up to 2025: A modelling study, The Lancet Public Health (2017)
[9] HMSO, With respect to old age: Long-term care—Rights and responsibilities. Royal Commission on Long-term care, HMG Cm 4192-1 (1999)
[10] Karlsson, M.; Mayhew, L.; Plumb, R.; Rickayzen., B., Future cost for long-term care: Cost projections for long-term care for older people in the United Kingdom, Health Policy, 75, 187-213 (2006)
[11] Kenny, T.; Barnfield, J.; Daly, L.; Dunn, A.; Passey, D.; Rickayzen, B.; Teow., A., The future of social care funding: Who pays?, British Actuarial Journal, 22, 1, 10-44 (2017)
[12] Kings Fund, A new settlement for health and social care—Final report. Commission on the Future of Health and Social Care in England, The Kings Fund (2014)
[13] Mayhew, L., Means testing adult social care in England, The Geneva Papers on Risk and Insurance—Issues and Practice (2017)
[14] Mayhew, L.; O’Leary, D.; Smith, D., Paying for care costs in later life using the value in people’s homes, The Geneva Papers on Risk and Insurance—Issues and Practice (2016)
[15] Mayhew, L.; Karlsson, M.; Rickayzen., B., The role of private finance in paying for long-term care, The Economic Journal, 120, 478-504 (2010)
[16] Mayhew, L.; Smith., D., Personal care savings bonds: A new way of saving towards social care in later life, The Geneva Papers on Risk and Insurance—Issues and Practice, 3, 668-92 (2014)
[17] Murtaugh, C.; Spillman, B.; Warshawsky., M., In sickness and in health: An annuity approach to financing long-term care and retirement income, Journal of Risk and Insurance, 68, 225-54 (2001)
[18] Pauly, M., Optimal public subsidies of nursing home insurance in the United States, The Geneva Papers on Risk and Insurance, 14, 50, 3-10 (1989)
[19] Pauly, M., The rational nonpurchase of long-term-care insurance, Journal of Political Economy, 98, 1, 153-68 (1990)
[20] Pickard, L.; Comas-Herrera, A.; Costa-Font, J.; Gori, C.; Di Maio, A.; Patxot, C.; Pozzi, A.; Rothgang, H.; Wittenberg., R., Modelling an entitlement to long-term care services for older people in Europe: Projections for long-term care expenditure to 2050, Journal of European Social Policy, 17, 1, 33-48 (2007)
[21] Poole, T., Funding options for older people’s social care (2006)
[22] Rickayzen, B., Cass Business School, City, An analysis of disability-linked annuities. Internal Research Report No. 180 (2007), University of London: University of London, London, UK
[23] SCIE, Eligibility determination for the Care Act (2015), Social Care Institute for Excellence
[24] Sloan, F.; Norton., E., Adverse selection, bequests, crowding out, and private demand for insurance: Evidence from the long-term care insurance market, Journal of Risk and Uncertainty, 15, 201 (1997) · Zbl 0900.90204
[25] Steventon, A.; Roberts., A., Estimating length of stay in publicly-funded residential and nursing care homes: a retrospective analysis using linked administrative data sets, BMC Health Services Research, 12, 1, 377 (2012)
[26] The Centre for the Modern Family, The cost of care—The financial and emotional impact of providing social care for family members, Scottish Widows (2017)
[27] Wanless, D., Securing good care for older people—Taking a long-term view, The Kings Fund (2006)
[28] Warshawsky, M., Retirement income: Risks and strategies (2012), Cambridge, MA: MIT Press, Cambridge, MA
[29] Which? (2017)
[30] Wittenberg, R.; Pickard, L.; Malley, J.; King, D.; Comas-Herrera, A.; Darton., R., Future demand for social care, 2005 to 2041: Projections of demand for social care for older people in England [online], PSSRU discussion paper 2514 (2008)
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