Research

[1.] " Pathways in long-term care and its determinants: evidence from Dutch administrative data", with Rob Alessie, Max Groneck and Raun van Ooijen. 2023. (JOB MARKET PAPER)

Abstract: We examine the determinants of transitions into and out of long-term care (LTC) arrangements (no LTC, home-based care, or institutional care), given the severity of the need for care. We document that the time spent with a low physical impairment in home-based care is shorter than with a low cognitive impairment; also, individuals with a low or high physical impairment are more likely to transition back to home-based care or no LTC. Next, we use a multi-state model to examine whether the availability of informal care, income, and assets affects transitions between different LTC arrangements. Our findings highlight that having a partner or children can be an important source for informal care, i.e., delaying the use of more specialized care and fostering the use of less specialized care. However, while having a healthy partner delays institutional care use of physically impaired home-based care users by 20pp., this, surprisingly, accelerates the use of institutional care of cognitively impaired home-based care users by 19pp.. Also, having more income, assets, or an own house implies using less specialized care. These insights help guide the ongoing shift to home-based care in many countries that face the challenges of an aging population and a declining availability of informal care.

Presented at: 2nd Health Economics Workshop (2022), Copenhagen (Denmark); EuHEA Conference (2022), Oslo (Norway); Netspar International Pension Workshop (2023)

[2.] "Combining Old-Age Insurances to Accommodate Inequalities in Long-Term Care and Mortality", with Rob Alessie, Max Groneck and Raun van Ooijen. 2023 (Submitted).

Abstract: We study adverse selection in annuity and long-term care (LTC) insurance markets and potential gains from a combination of insurances. Using unique administrative data from the Netherlands, we find opposing socioeconomic gradients in mortality and LTC which strongly differ over gender and informal care possibilities. These heterogeneous risks imply adverse selection for single annuity-, and LTC insurances. We theoretically and empirically derive conditions for an optimal combination of insurances minimizing adverse selection. Our results indicate that despite reverse gradients, a combined life care annuity is best feasible for single men and women but less so for married men and women.

Presented at: EEA Congress (2020), Virtual; Workshop on Longevity Risk, Differential Mortality and Lifetime Inequality (2018), Brescia (Italy). 

Media coverage: Invited to write press summary for EEA congress 2020.

[3.] "Health inequalities and the progressivity of old-age social insurance programs", mimeo, with Max Groneck and Raun van Ooijen. 2021.

Abstract: We examine the redistribution of welfare in old-age social insurance programs. We consider both redistribution of benefits due to inequalities in long-term care (LTC) needs and mortality and redistribution through progressive social security taxes and means-tested LTC co-payments. To this end, we model consumption and saving behavior of singles and couples throughout the life-cycle. Households face uncertain labor income at working age and uncertain and heterogeneous health and mortality across socioeconomic groups implying precautionary savings to differ across these groups. In addition, we assume that households value giving bequests to their heirs, implying a potential saving motive for bequests. We estimate the parameters of the model using unique administrative data from the Netherlands. Old-age insurance programs imply a strong redistribution of welfare due to socioeconomic inequalities in LTC needs and mortality. The welfare effect amounts to almost half a year of additional consumption for the income rich compared to those in the bottom lifetime income quartile. A large part of the excess welfare gain for richer households is explained by their strong preferences for leaving bequests: the rich spend a shorter amount of time in LTC, implying less co-payments and a larger bequest upon death.

Presented at: CEBI lunch seminar (2022), Copenhagen (Denmark); iHEA Congress (2021), Virtual; Annual Conference of the International Association for Applied Econometrics (2021), Virtual; North American Summer Meeting of the Econometric Society (2021), Virtual.

This is my master's thesis, which is awarded the Jan Brouwer Scriptieprijs 2021 by the Royal Holland Society for Sciences and Humanities (Koninklijke Hollandsche Maatschappij der Wetenschappen, KHMW).  The KHMW posted their jury report on their webpage.

[4.] "Estimating left-truncated shared-frailty models with time-varying covariates", mimeo, with Gerard van den Berg. 2023.

Abstract: Shared frailty models with frailty terms that are independent of the observed covariates are the duration data equivalent of linear panel data models with random effects. We consider likelihood-based estimation of shared frailty models if observed durations are left-truncated, covariates can be time-varying, and a random effect is shared among an arbitrary amount of spells. Our estimation procedure accommodates dynamic selection on both observed and unobserved characteristics, which makes the observed left-truncated sample selective with respect to the underlying population. We deliver a general and novel STATA routine for our estimation procedure. We provide an example where the biases in duration dependence and covariate effects that arise if truncation is not properly taken care of are substantial at a low number of shared spells but eventually approach zero for a higher number of spells. At the same time, the frailty variance is increasingly overestimated. 

Presented at: Groningen Metrics Meet (GMM) (2023)

[5.] "Financial Consequences of Widowhood", Netspar Design paper 160, with Rob Alessie and Raun van Ooijen. 2020.

Abstract: This paper studies the impact of widowhood on the income position of surviving spouses, before and after the normal retirement age. Moreover, we consider the importance of public survivor benefits and other sources of income that alleviate the financial consequences of widowhood.  To further understand the degree of income protection provided by public survivor benefits, we analyze the impact of a substantial reform of the survivors' benefits scheme in 1996 that imposed stricter eligibility criteria and a means-tested benefit level for cohorts born after 1949. Using rich administrative data, we find that, three years after widowhood, women of working age experience an about twenty percent reduction in equivalized disposable household income. In contrast, retired widows can maintain their previous standard of living. The survivor's benefit reform resulted in a further reduction in the standard of living of working-age widows, particularly for women with a high pre-widowhood household income who work less after the reform. While men experienced a thirty percent increase in equivalized income before the reform, their standard of living remains fairly constant after the reform because their labor supply remains unchanged.

Presented at: EEA congress (2021).

Media coverage: Invited to write summary for the magazine Geron.