Four questions are addressed:
Starting from an examination of the essential components of the long established 'contract' between the generations, the analysis moves on to examine public policy responses to the ageing of populations. Observing an international inclination to panic at the growth of old age and to restrict expenditure on services to older people, the paper addresses practical questions of political economy within the generational contract. On the one hand cuts to pensions and services are seen not to be economically inevitable. On the other it is argued that modern retirement breaches the compact between the generations and will need to be reformulated, enabling more people to earn income well beyond current retirement ages.
The reformulation of the regulation of long-term care seen in the recent White Paper and Royal Commission in the UK has led to topical debates on long-term care for older people. Given that there are over 500,000 people in residential nursing and dual registered homes across the country, there has, until now, been remarkably little research on the role of managers in the long-term care sector, the various tasks they undertake in the day-to-day operation of a care home, and the qualities and qualifications they bring to their work. This study investigates the range of tasks which managers of long-term care homes perform, and the skills they should possess to do their work. The opening chapter reproduced here provides a critical analysis of the current confusion which besets UK policy on long term care.
There is probably no policy-maker in Canada who has not heard "the boom, bust and echo" mantra of David Foot (1996) by now. Even those who have not fallen prey to Foot's mantra are aware that between 2025 and 2031, the population aged 65 and over will reach between 20 and 25 percent of the total Canadian population. While the timing of this trend is somewhat later for Canada than it is for some northern and western European countries, policy makers in Canada and in many other countries of the Organisation for Economic Co-operation and Development (OECD) are receiving conflicting messages about what the future growth of the elderly population will mean for the provision of health care services and health care expenditures.
There are those who believe that because seniors account for a disproportionate part of health expenditures relative to their proportion of the population, that as this proportion grows health care expenditures will either explode or the health care system will have to be reconstructed in ways which are incompatible with the current values of health care systems in Canada as defined by the Canada Health Act (i.e., public administration, comprehensiveness, universality, portability, and accessibility). Alternatively, there are those who believe that the growth in the seniors population is only one component which is driving costs and that those components are manageable.
In this paper, the relationship between population ageing and future health care costs is assessed based on evidence from the Canadian and international literature on this topic. The contributing factors to health care system costs and how they interface with an ageing population are identified. The paper also assesses where new research is needed if the publicly-financed health care system is to evolve to respond to the needs of an ageing population in a fiscally and socially responsible manner.
This report makes available a range of projections of the Canadian population and labour force based on information that is up-to-date at the time of release. The projections extend to 2046 under three sets of assumptions: "standard", "higher population growth", and "lower population growth". The report provides an indication of the capabilities of the MEDS software on which the projections are based.
This report makes available projections of the population and labour force of each of the provinces and territories of Canada. The projections extend to 2046, and are based on information that is up-to-date at the time of release. The report provides an indication of the capabilities of the MEDS software on which the projections are based.
This research evaluates the location of adult children as a determinant of interstate primary migration for elderly (aged 60+) blacks and whites, over the 1985-90 period. We find that the location of adult children, as well as environmental amenities, affect the migration of both elderly blacks and whites but exert different redistribution influences on each race. Our results support the migration implications of Eugene Litwak's theory of the "modified extended family", which is considered to be more viable than the isolated nuclear family in a modern society.
Given the growing ethnocultural diversity of Canada's aging population and the increased research focus on the role of the family in the social support of older persons, it is important to explore the ways in which adult ethnic minority children provide assistance to older parents within the context of the family. The current study contributes to research on intergenerational support systems in later life in Japanese Canadian families by examining the factors, particularly the cultural value of oya koh koh (filial obligation), affecting the nature of support from adult children to older parents.
Using data gathered from interviews with 100 older nisei (second generation) parents and 100 adult sansei (third generation) children in British Columbia, the study focuses on the frequency, quality and provision of three types of support: emotional, service, and financial.
Results of logistic regression analyses indicate that oya koh koh has a significant effect on children's provision of emotional support, but no effect on financial or service support. Parent's health and socioeconomic status are found to have significant effects on children's provision of financial and service support. Child's availability is also a major determinant of financial support. Further, ordinary least squares (OLS) regression analyses results suggest that oya koh koh has a significant effect on the quality of emotional support provided by children to their parents. Findings are discussed in terms of the North American Asian "ideal" family myth and directions for future research.
Between 1970 and 1986 all Canadian provinces introduced some version of a prescription drug subsidy for those age 65 or over and since 1986, all the provinces have increased copayments or deductibles to some degree. Employing a first-order approximation to the welfare gains from a subsidy, we find evidence that these subsidies have been less redistributive than an absolute per household cash transfer but slightly more redistributive than a transfer that would increase each household's income by the same percentage. Such evidence may have relevance for predicting the redistributive effects of a potential national prescription drug plan for seniors in the United States.
The purpose of this study was to determine the prevalence, types, and severity of disabilities, as well as the medical conditions that may have caused disabilities among non-institutionalized older adults by high and low income. Disabled individuals aged 55 years and older were identified from the 1986 and 1991 Health and Activity Limitation Surveys. The overall unweighted sample sizes for each survey were 132,337 in 1986 and 91,355 in 1991.
Approximately 40% of senior men and women reported having at least one disability, with women just slightly more likely than men to report being disabled. Almost twice as many senior women had low income compared with senior men. Mobility and agility disabilities were the most common types of disabilities reported by older adults. Arthritis/rheumatism was the medical condition most often reported as the primary cause of a disability among women. Men most often reported diseases of the ear and mastoid processes, with differences reported by low and high income respondents.
Among 55-64 year olds, low income respondents were generally less likely to be categorized as mildly disabled and more likely to be categorized as severely disabled compared with high income respondents. In an effort to postpone or prevent disabilities in an ever-growing older population, public health initiatives are required to educate older adults about medical conditions and impairments that often lead to disability, particularly among low income seniors.
An important demographic trend is the aging of the population. As a result, demand for health care services for the sick and elderly is likely to increase. Since care for the sick and elderly is often provided informally by family members, parental illness may have important implications for the labour supply of adult children.
Although previous studies show a negative relationship between hours worked and caregiving, they do not account for the potential endogeneity of the parental living arrangement to the child's labour supply. Using panel data and controlling for such endogeneity, I find that caregiving and cohabiting with a sick, elderly parent appear to have smaller effects on labour supply than the past literature suggests. Nonetheless, since cohabiting with a sick elderly parent does have negative effects on the labour supply of women and given that this form of living arrangement is relatively common, the aggregate costs associated with informal caregiving in an intergenerational living arrangement are considerable.
Sixty-five has long been used to define the beginning of 'old age'. Yet it is clear that the definition is arbitrary, and with continuing reductions in mortality and morbidity rates it will become increasingly inappropriate as time passes. We consider how the definition might be modified to reflect changes in life table probabilities, and how the future numbers and proportions in 'old age' would be affected. In a similar manner we consider also the redefinition of the 'oldest old' from a current definition of 85 and over.
The major focus of this paper is on the geographic dimensions of population aging in Canada between 1991 and 1996 and the demographic processes which underlie them. The question we address is how the proportion of the population that is over 65 changes in the period from 1991 to 1996 and the way in which these changes relate to the demographic and socio-economic attributes of small areas. We develop an accounting framework which links changes in the elderly population to the two components of aging-in-place and net migration for both elderly and non-elderly populations in each area and demonstrate how the structure of these two components defines differing aging profiles in different parts of the country. Aging in the southern parts of Saskatchewan and Manitoba, together with much of the Atlantic provinces are dominated by net migration while aging-in-place dominates in much of the rest of the country. The geographical structure of aging in the early nineties is also compared with outcomes of an earlier analysis of aging in the latter half of the eighties.
The paper goes beyond the representation of components of population aging within an accounting framework. Communities with more active and growing local economies are particularly attractive to younger migrants while those communities with declining economic opportunities are likely to see younger populations depart at a faster rate than older individuals. Sustained over longer periods of time, these processes produce shifts in the age structure of local communities and would lead us to expect that both the structure and processes of population aging would be intimately linked to the economic geography of the national landscape. This paper shows that the geography of aging is strongly linked to the geography of economic disadvantage, indicating that those areas which have both high and growing proportions of elderly are most likely to be areas of slow growth with below average incomes
We present a measure of the correlation between the education levels of spouses based on a bivariate ordered probit model. The change in this correlation over time can be measured while controlling for the large changes in the educational attainment levels. The model is estimated with data from 20 Surveys of Consumer Finances in Canada over 1971-1996. Our main findings are a reduction in this correlation among younger couples beginning in the 1980s, and an inverted U- shaped effect of the spouses' age difference on the correlation, with the maximum correlation occurring approximately when the spouses' ages are equal.
Federal tax reform in 1988 flattened the Canadian personal income tax schedule, changing the marginal tax rates for many individuals. Using methods similar to those applied by Auten and Carroll (1999) in the study of the effects of the 1986 U.S. Tax Reform Act, we estimate the responsiveness of income to changes in taxes to be substantially smaller in Canada. However we find evidence of a much higher response in self-employment income, in the labour income of seniors and from those with high incomes.
The use of self assessed health status as a measure of health is common in empirical research. We analyse a unique Australian survey in which a random sub-sample of respondents answer a standard self assessed health question twice – before and after an additional set of health related questions. 28% of respondents change their reported health status. Response instability is related to age, income and occupation. We also compare the responses of these individuals to other respondents who are queried only once. The distributions of responses to both questions by the former group are statistically different from the distribution of responses by the latter group.
Contributions to tax-preferred savings accounts are typically constrained by a contribution limit. These limits influence contributions not just in periods in which they bind, but in other periods as well. I develop a simple life-cycle model in which consumers exhibit "use-it-or-lose-it" contribution behaviour. This connects current contributions to future contribution limits, which leads to the result that an increase in contribution limits can decrease contributions. Empirical evidence provides support for the model--larger future contribution room is associated with smaller contributions.
The life-cycle model is the standard framework which economists use to think about the intertemporal allocation of time, money and effort. The model suggests that households should `smooth' expenditures. One of the strengths of the model is that it provides a single framework which integrates allocation at many different frequencies. Accordingly, we provide an assesment of the life- cycle model by re-examining the empirical evidence for smoothing (1) within the year, (2)at year-to-year or business cycle frequencies, (3) over the working life, and (4) across the stages of life, such as working into retirement.
We conclude that although unresolved challenges remain, the model has had many more successes than failures. We provide some calculations that show that where deviations from the model's predictions have been detected, they imply very small welfare costs for households. Moreover, economists are really just beginning systematic application of general theory models to microdata. Thus it is much too early to abandon the life-cycle model.
The effects of population change on requirements for physicians in Ontario are studied. Principal findings are the following: (a) contrary to popular belief, the overall increase in requirements will be significantly lower in 2000-2020 than in the preceding two decades; (b) population aging alone will raise the overall rate of growth of requirements but that will be more than offset by slower population growth; (c) the main effect of aging will be on the distribution of requirements among categories of physicians. These findings suggest that the emphasis on population aging in policy discussions of future overall physician requirements is unwarranted.
This paper considers nonparametric identification of "latent" competing risks and Roy duration models in which one does not know which process has been observed. It is shown that these models are identifiable without the usual conditional independence and exclusion restrictions. These results can be applied to many retirement and aging decisions including: time to retirement between spouses, financial planning, and health related retirement decisions.
A simple structure is suggested for modelling unobserved heterogeneity in multivariate duration models which avoids the "curse of dimensionality" and numerical integration of the likelihood function. This structure can be applied to many retirement and aging decisions including: time to retirement between spouses, financial planning, and health related retirement decisions.
This paper develops and estimates a structural model to explain lengths of stay of psychiatric patients as the joint decision of patients and caregivers. The hazard rates are estimated using Weibull specifications for the duration dependence and a multivariate version of the Gamma distribution to allow for unobserved and correlated heterogeneity.
The main results indicate that the hazard rate for the caregivers' is increasing while that for the patients' is decreasing. Moreover, the older the patient is, the lower is the hazard rate for both patients and caregivers. This model can also be applied to many retirement and aging decisions including: time to retirement between spouses, financial planning, and health related retirement decisions.
401(k)-type pension arrangements are the most popular tax subsidy to household saving in the U.S. This study uses self- and firm-reported pension information, Social Security, and household wealth data from 1992 Health and Retirement Study (HRS) to examine the extent to which 401(k) pension plans have raised household saving. Comparison of self- and firm-reported pension information indicates significant measurement error in self-reported 401(k) eligibility. This error has biased the estimated 401(k) saving effects in all previous studies upward significantly and differentially by income category. There is evidence of significant measurement error in pension assets as well.
Overall, the estimates that account for both types of measurement error suggest that 401(k)s have not raised household saving. All of the estimates are significantly lower than those implied by previous studies that have found large effects. The most plausible explanation for the large estimated offset to household saving is firm-level substitution of 401(k)s for other pensions. Even though very little of the average dollar of 401(k) wealth appears to be new household saving, 401(k)s may have stimulated saving significantly for lower-to-middle income households and, hence, increased retirement income security for an important segment of the population.
For some time researchers have known that the relationship between health and the residential mobility of the elderly is not straight forward and changes with age. Attempts to examine this relationship in multi-variate models using cross-sectional data have resulted in contradictory or ambiguous findings. One solution has been to create separate models for different age groups. However, the onset of poor health differs considerably by individual, particularly for the "young-old". Multi-variate proportional hazards models using longitudinal data offer a new approach to address this problem.
As an example, data from the Ontario Longitudinal Study of Aging have been analyzed using proportional hazards models as compared with logistic regressions. The logistic regressions yield typically ambiguous results. The proportional hazards models indicate a reversal with time in the relationship between one of the two mid-life health measures and residential mobility, and the results for both measures are consistent with the theoretical literature.
This is a review article of three books that deal with the problems facing the U.S. Social Security system. One deals with the OASDI (Old-Age, Survivors and Disability Insurance) financial shortfall and proposes an alternative plan with both a tier one benefit and a tier two provision based on personal saving accounts. A second considers the social insurance system more comprehensively, arguing for a grand reform which would include new programs, particularly in the areas of child care and housing. A third largely confines itself to arguing against those who wish to change the OASDI plan because of the financial projections, although it also argues for a more comprehensive health care insurance system. The review concludes that key differences expressed in the books, particularly between the first and third, rest on different value judgments regarding intergenerational equity and the role of government.