Wealth patterns among elderly Americans: Implications for health care affordability

Health Affairs

Volumn 22, Issue 3, 2003, Pages 168-174

  Knickman, James R ^a   Hunt, Kelly A ^b   Snell, Emily K ^c   Alecxih, Lisa Maria B ^d   Kennell, David L ^e  

^a ROBERT WOOD JOHNSON FOUNDATION   (United States)

^b RWJF Research and Evaluation Unit

^c NORTHWESTERN UNIVERSITY   (United States)

^d LEWIN GROUP   (United States)

^e Kennell and Associates Inc   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; COMPARATIVE STUDY; ECONOMICS; ELDERLY CARE; FINANCIAL MANAGEMENT; FORECASTING; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HUMAN; INCOME; SOCIAL CLASS; STATISTICS; TERMINAL DISEASE;

AGED; CATASTROPHIC ILLNESS; FINANCING, PERSONAL; FORECASTING; HEALTH EXPENDITURES; HEALTH POLICY; HEALTH SERVICES ACCESSIBILITY; HEALTH SERVICES FOR THE AGED; HUMANS; INCOME; SOCIAL CLASS;

EID: 0037711355     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.22.3.168     Document Type: Review

References (25)

1. Henry J. Kaiser Family Foundation, "The Medicare Program: Medicare at a Glance," October 2002, www.kff.org/content/archive/1066/1066-04v2.pdf (12 November 2002);
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4. and M.A. Laschober, et al., "Trends in Medicare Supplemental Insurance and Prescription Drug Coverage, 1996-1999," 27 February 2002, www.healthaffairs.org/WebExclusives/Laschober_ Web_Excl_022702.htm (12 November 2002).
5. U.E. Reinhardt, "Turning Our Gaze from Bread and Circus Games," Health Affairs (Spring 1995): 33-36;
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7. N. Gilbert and K.G. Troitszch, Simulation for the Social Scientist (Buckingham: Open University Press, 1999).
8. J.M. Wiener, L.H. Illston, and R.J. Hanley, Sharing the Burden (Washington: Brookings Institution, 1994).
9. U.S. Census Bureau, March 1994 Current Population Survey (Washington: Census Bureau, 1994). These data were chosen because an exact match to the Social Security earnings histories of those in the March 1994 sample was available. The use of actual earnings histories to project future earnings and Social Security income means that the model has significant advantage over those that only have information for a point in time.
10. Social Security Administration, 1999 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Disability Insurance Trust Funds 1999, www.ssa.gov/pub/oact/tr99.pdf (21 February 2003). This report is the basis for projections of future flows of money into and out of the Social Security system. The Intermediate Scenario assumes that wages will grow annually over the thirty-year period approximately one percentage point more than inflation.
11. J.R. Knickman and E.K. Snell, "The 2030 Problem: Caring for Aging Baby Boomers," Health Services Research 34, no. 4 (2002): 849-884.
12. J.R. Knickman and E.K. Snell, The 2030 Problem: Caring for Aging Baby Boomers, Health Services Research 2002 34 4 849-884. Ibid.
13. G.S. Gabrel, An Overview of Nursing Home Facilities: Data from the 1997 National Nursing Home Survey, Advance Data from Vital and Health Statistics, no. 311 (Hyattsville, Md.: National Center for Health Statistics, 2000);
14. and G.S. Gabrel, Characteristics of Elderly Nursing Home Current Residents and Discharges: Data from the 1997 National Nursing Home Survey, Advance Data from Vital and Health Statistics, no. 312 (Hyattsville, Md: NCHS, 2000).
15. T. Smeeding, "Nonmoney Income and the Elderly: The Case of the Tweeners'," Journal of Policy Analysis and Management 5, no. 4 (1986): 707-724.
16. K.G. Manton, L. Corder, and E. Stallard, "Chronic Disability Trends in Elderly United States Populations: 1982-1994," Proceedings of the National Academy of Sciences 94, no. 6 (1997): 2593-2598.
17. K. McGarry and R.F. Schoeni, "Widow Poverty and Out-of-Pocket Medical Expenditures at the End of Life" (Unpublished paper, University of California, Los Angeles, and University of Michigan, 18 October 2001).
18. Because Medicaid eligibility rules are different from the criteria for the Medicaid Bound in the analysis, the model's simulation of Medicaid long-term care users is higher.
19. U.S. Bureau of the Census, "Years of School Completed by People Age 25 and Older, by Age and Sex: Selected Years 1940 to 2000," Table A-1, 19 December 2000, www.census.gov/population/socdemo/education/tableA-1.txt (21 February 2003).
20. U.S. Bureau of Labor Statistics, Civilian Employment, Series LFS1600002, www.bls.gov/webapps/legacy/cpsatabl.htm (interactive site; specify the data series).
21. Authors' calculations from U.S. Bureau of the Census, Current Population Survey, Annual Demographic Supplements, "Type of Family (All Races) by Median and Mean Income: 1947 to 2001," Table F-7, 30 September 2002, www.census.gov/hhes/income/histinc/f07.html (11 March 2003);
22. U.S. Bureau of the Census, Current Population Reports, "America's Families and Living Arrangements: March 2000," Series P20-537, June 2001, www.census.gov/prod/2001pubs/p20-537.pdf (11 March 2003);
23. and U.S. Bureau of the Census, Current Population Reports, "Married Couples by Labor Force Status of Spouses: 1986 to Present," Table MC-1, 29 June 2001, www.census.gov/population/socdemo/hh-fam/tabMC-1.txt (11 March 2003).
24. For example, the High Cost assumptions used by the Social Security trustees reflect much lower real-wage growth assumptions. SSA, 1999 Annual Report.
25. Alternative assumptions about dissavings have been modeled as sensitivity analyses, and, as expected, if dissaving becomes the norm in earlier years of retirement, the simulation model predicts fewer Financially Independent elderly and more Medicaid Bound than reported in Exhibits 3 and 4. However, the general pattern of increased wealth and income presented in the paper - although more modest than reported - remains the same under all reasonable assumptions about dissavings in retirement years.