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Dissertation Defense for Jonathan Hurdelbrink
Program: ECONOMICS: PHD
Department Contact Email: firstname.lastname@example.org
Defense Title: Essays in the Economics of Long Term Care Utilization
Defense Date and Time: 07/11/16 12:00 pm
Defense Location: Paul College Room 370N
Defense Advisor: Reagan Baughman
Defense Abstract: With the United States population over the age of 65 expected to more than double by 2060, the demand for long-term care services that help individuals with physical limitations or cognitive impairments is expected to significantly increase. As a result, it has become increasingly important to understand how individuals decide which type(s) of long-term care and how much care to use. Each of the three chapters of my dissertation examines a distinct determinant of long-term care utilization using longitudinal data from the Health and Retirement Study between 1998 and 2012. The first chapter exploits temporal variation in economic conditions both nationally and at the county levels to examine how changes in the macroeconomy like the Great Recession affect long-term care utilization. The empirical results suggest that the peak to trough difference in the unemployment rate during the Great Recession implies an 8.4 % reduction in overall care utilization in the national analyses and a 9.5 % reduction in the county analyses. In addition, informal home care is found to be the type of care that is most significantly affected by changes in economic conditions. The second chapter examines the effects of the Deficit Reduction Act of 2005 on long-term care; this policy was designed to prevent individuals from transferring away their assets to qualify for Medicaid long term care benefits. Using a difference-in-difference identification strategy in which the treatment and control groups are defined by pre-2005 asset levels, I find that individuals are 19% less likely to make asset transfers and 20% more likely to hold assets in revocable trusts following the DRA. In addition, I find that individuals are 14% less likely to use any long-term care but more likely to both visit the doctor more frequently and use adult day care facilities following its enactment. The final chapter examines the relationship between parent-to-child inter-vivos asset transfers and future informal care provision by an adult child. By taking advantage of the wording of particular survey questions in the Health and Retirement Study, I am able to observe care provision that follows a transfer, descriptively examine if such a relationship exists and if so, identify what specific types of care and caregivers are affected. I find that there is a significant relationship between transfers and care, specifically for female, married children who help their parents with IADL limitations. Overall, this research helps to broaden our understanding of the economic, policy and financial factors of long-term care utilization and may help to ensure that efficient care will be available to accommodate this future demand.
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