The Socioeconomic Health Gradient and Rising Old-Age Inequality

社会经济健康梯度和日益加剧的老年不平等

• 批准号: 391587678
• 负责人: Professor Dr. Holger Strulik
• 金额: --
• 依托单位: Lehrstuhl für Makroökonomik und Entwicklungsökonomik
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2018
• 资助国家: 德国
• 起止时间: 2017-12-31 至 2021-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/391587678?language=en
• 关键词: Socioeconomic; Health; Gradient; Rising; Old

In this project we investigate the interaction between socioeconomic status, health care expenditure, longevity, and old-age poverty in a social welfare system. In particular we aim to assess to which degree the German and Swiss social welfare system mitigate or amplify pre-existing inequality trends. Our particular focus is on the transmission of the inequality of earnings on the inequality of health status of the elderly, longevity and old-ageconsumption. The treatment of life expectancy as being endogenously explained is keysince we argue that the rising socioeconomic gradient in health is both cause and consequence of rising old-age inequality. It is a cause because in a pay-as-you-go (PAYG) pension system any disproportionate increase of longevity of the rich places an extra burden on the (annual) pensions that can be expected by the poor (holding contribution rates constant). It is aconsequence because deteriorating pension income of the poor further rations access to health care, health, and longevity. In fact, health care rationing is more and more prevalent as a consequence of rising health costs and rising insurance premia. Some treatments would thus have to be paid without insurance coverage and may become unaffordable for poorer individuals.Consequently, declining pensions that result from demographic Change potentially aggravate old-age health inequality. The notion of endogenous longevity is thus essential to see how a social welfare system can contribute to the emergence of an old-age poverty trap. This project is motivated by our earlier SNF-DFG financed Project "Optimal Health and Retirement Policy under Biologically Founded Human Aging" where we integrated into modern macroeconomics a biologically founded process of individual ageing and investigated the interaction of pensions and health expenditure with respect to health outcomes and welfare. Although inequality was not the focus of the project, we found, quite surprisingly, that even optimally designed insurance systems(that maximize the value of life behind the veil of ignorance) may create and amplify inequality when health deficit accumulation is conceptualized as controlled stochastic process. Income inequality (aside from that originating directly from bad health), however played no role in our earlier project where people were assumed to be identical aside from their healthstatus. In the new project, by contrast, we focus on how pre-retirement earnings inequality is translated into late-life inequality in income and health and how pre-retirement inequality is potentially mitigated or amplified in old age by the social welfare system. Specifically we aim to investigate how stylized versions of the German and Swiss pension and healthsystem affect the transmission of inequality. We then derive proposals for reforms of the social welfare systems that mitigate old-age inequality.

本课题研究社会福利制度下的社会经济地位、医疗费用、寿命和老年贫困之间的相互作用。特别是，我们的目标是评估德国和瑞士的社会福利制度在多大程度上减轻或扩大了先前存在的不平等趋势。我们特别关注收入不平等对老年人健康状况、寿命和老年消费不平等的传导。将预期寿命视为内生性解释是关键，因为我们认为，健康方面不断上升的社会经济梯度既是老年不平等加剧的原因，也是其结果。这是一个原因，因为在现收现付（PAYG）养老金制度中，富人寿命的任何不成比例的增加都会给穷人（保持缴费率不变）预期的（年度）养老金带来额外负担。这是一个必然的结果，因为穷人日益恶化的养老金收入进一步限制了他们获得医疗保健、健康和长寿的机会。事实上，由于医疗费用和保险费不断上涨，医疗配给越来越普遍。因此，一些治疗费用将不得不在没有保险的情况下支付，贫困者可能负担不起，因此，人口变化导致的养老金下降可能加剧老年人健康不平等。因此，内生长寿概念对于了解社会福利制度如何有助于老年贫穷陷阱的出现至关重要。这个项目的动机是我们早期的SNF-DFG资助的项目“生物学基础的人类老龄化下的最佳健康和退休政策”，我们将现代宏观经济学纳入生物学基础的个人老龄化过程，并调查养老金和健康支出与健康结果和福利的相互作用。虽然不平等不是该项目的重点，但我们发现，非常令人惊讶的是，即使是设计最优的保险制度（最大化无知之幕背后的生命价值）也可能会在健康赤字积累被概念化为受控随机过程时创造和放大不平等。然而，收入不平等（除了直接源于健康状况不佳）在我们早期的项目中没有发挥作用，在这个项目中，人们被认为除了他们的健康状况之外是相同的。相比之下，在新项目中，我们关注的是退休前的收入不平等如何转化为晚年收入和健康的不平等，以及社会福利制度如何在老年时潜在地减轻或放大退休前的不平等。具体来说，我们的目标是调查德国和瑞士的养老金和医疗体系的程式化版本如何影响不平等的传递。然后，我们提出了改革社会福利制度，减轻老年不平等的建议。