ISE 2024年第1期：人口老龄化、医疗保健与宏观经济专辑(摘要全）

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编按：本期是黄晓东、赵开两位共同主编组织的人口老龄化、医疗保健与宏观经济专辑，主要包含美国医疗保险制度改革的宏观经济影响、泰国在应对老龄化方面的社保及财政挑战、美国的经济情况调查和社会保障、死亡的主观预期如何影响社保申领行为、中国的家庭代际转移、生育决定和对年迈父母的代际支持规范等。

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Macroeconomicconsequences of alternative reforms to the health insurance system in theUnited States

Abstract: This paper presents a dynamicgeneral equilibrium model designed to examine the macroeconomic effects andwelfare implications of alternative reforms to the US health insurance system.Specifically, it scrutinizes the extent to which health care reform canmitigate inefficiencies stemming from market imperfections in the healthinsurance industry. The model considers a stochastic overlapping generationsframework, incorporating heterogeneous agents who are subject to uncertainhealth shocks. These individuals make optimal decisions regarding labor supply,health insurance, and medical services. Given that the optimal levels ofmedical consumption and hours worked are endogenous, this setting encapsulatesgeneral equilibrium effects. The model is calibrated to US data, and numericalsimulations suggest that suitable adjustments to the present health insurancesystem can broaden coverage and enhance welfare. This improvement is achievedby reducing adverse selection, improving overall health status, and lesseningtax distortions on labor supply.

美国医疗保险制度改革的宏观经济影响

摘要：本文构建了一个动态一般均衡模型，以探究美国医疗保险体系改革对宏观经济和社会福利的影响。具体来说，该模型旨在评估医疗改革在多大程度上能够缓解由于医疗保险市场不完善而导致的效率损失问题。模型采用随机世代交叠框架，引入了面临不确定健康冲击的异质性个体。这些个体在劳动供给、医保选择和医疗服务消费方面做出最优决策。考虑到医疗消费和劳动时间的最优水平是内生决定的，该模型设定包含了一般均衡效应。我们利用美国数据对模型进行了校准。数值模拟结果表明，通过对现有医疗保险制度进行合理改革，可以扩大医保覆盖面，提升社会福利水平。这种改善主要通过减轻逆向选择问题、改善总体健康状况以及降低税收对劳动供给的扭曲来实现。

Aging,inadequacy, and fiscal constraint: The case of Thailand

Abstract: We use anoverlapping generations model to study the challenge in developing countrieswith a large informal sector and aging population. We use Thailand as a casestudy and incorporate its labor market structure and its public pension systeminto the calibrated model. Unlike developed countries, workers in developingcountries commonly transit from the formal sector to the informal sector, whichcan be in the early stage of their working life. This labor market featurecrucially limits the coverage of the contributory social security (SS) system.We find that 66% of Thai elderly (aged 60 or over) are ineligible for SSannuity benefits because of an insufficient number of years paying into the SSfund. In addition, we use our model to evaluate two schemes to raise theexisting universal basic pension income to the poverty line, namely, uniformbenefits and pension-tested benefits. We find that pension-testing effectivelyimproves the targeting efficiency, and nontrivially lowers the cost of the basicpension income program.

老龄化、社保缴费年限不足和财政限制：以泰国为例

摘要：我们采用世代交叠模型来研究非正规部门庞大、人口老龄化严重的发展中国家所面临的挑战。我们以泰国为例，将其劳动力市场结构和公共养老金制度纳入校准模型。与发达国家不同的是，发展中国家的工人通常会从正规部门转入非正规部门，这可能发生在他们工作生涯的早期阶段。劳动力市场的这一特点严重限制了缴费型社会保障体系的覆盖范围。我们发现，66% 的泰国老年人（60 岁或以上）没有资格享受社会保障年金福利，因为他们向社会保障基金缴费的年限不足。此外，我们利用模型评估了将现有全民基本养老金收入提高到贫困线的两种方案，即统一福利和养老金测试福利。我们发现，养老金测试有效地提高了目标效率，并大幅降低了基本养老金收入计划的成本。

Meanstesting and Social Security in the United States

Abstract：This paper uses aheterogeneous-agent overlapping-generations model to examine the fiscal anddistributional consequences of introducing a means test in US Social Security.I find that a means test, that is, conditioning benefit payments on ahousehold's earnings or assets, leads to a higher implicit tax on old-ageresources, but has desirable distributional effects. A 75% cut in the benefitsto households with earnings of more than 200% of the median leads to a 2.3%reduction in the overall size of Social Security, but has almost no effect onaverage dollar benefits. In contrast, a fiscally comparable payroll tax cutleads to an across-the-board decline of 2% in the average dollar benefits,despite an increase in capital and labor. A fiscally comparable delay in thebenefit eligibility age increases benefits for all, but negatively affectscapital and labor. Finally, an asset-based means test causes a decline of 1% inthe average dollar benefits, but has a large negative effect on capital and theaccidental bequests left behind by deceased households.

美国的经济情况调查和社会保障

摘要：本文使用一个异质代理世代交叠模型来研究在美国社会保障中引入经济情况调查的财政和分配后果。作者发现，经济情况调查，即以家庭收入或资产作为福利支付的条件，会导致对养老资源征收更高的隐性税，但会产生理想的分配效果。将收入超过中位数 200% 的家庭的福利削减 75%，会导致社会保障的总体规模减少 2.3%，但对平均美元福利几乎没有影响。相比之下，财政上同等规模的工资税削减却会导致平均美元福利全面下降 2%，尽管资本和劳动力会有所增加。在财政上具有可比性的福利领取资格年龄的延迟会增加所有人的福利，但会对资本和劳动力产生负面影响。最后，基于资产的经济情况调查导致平均美元福利下降 1%，但对资本和死亡家庭留下的意外遗赠有很大的负面影响。

How do subjective mortality beliefsaffect the value of social security and the optimal claiming ages

Abstract：Households that postpone claimingSocial Security benefits are, in effect, making additional purchases of theSocial Security annuity and acquiring valuable longevity insurance. This paperinvestigates the impact of plausible variations of subjective mortality beliefson the value of delayed claiming and the optimal claiming ages of retiredworkers. Using the Health and Retirement Study data, we show that olderindividuals could, on average, predict their life expectancy correctly;however, the average variance of age of death calculated from subjectivemortality tables is 6.2%–14.4% lower than that from cohort life tables. Usingnumerical optimization techniques, we further show that, theoretically, olderhouseholds place a lower value on delaying claiming when they have greaterconfidence in their ability to forecast their age of death. But the magnitudeof this effect is not large enough to change their optimal claiming ages,unless they hold extreme subjective mortality beliefs. As a result, we concludethat subjective mortality

beliefs alone cannot explain the prevalence of earlyclaiming behaviors.

死亡的主观预期如何影响社会保障的价值和最佳申领年龄？

摘要：推迟领取社会保障福利的家庭实际上是额外购买了社会保障年金，并获得了有价值的长寿保险。本文研究了死亡主观预期的合理变化对延迟申领价值和退休工人最佳申领年龄的影响。利用健康与退休研究数据，我们表明老年人通常情况下可以正确预测自己的预期寿命；然而，根据死亡的主观预期表计算的死亡年龄的平均方差比根据队列生命表计算的死亡年龄的平均方差低 6.2%-14.4%。利用数值优化技术，我们进一步表明，从理论上讲，当老年家庭对自己预测死亡年龄的能力更有信心时，他们会降低延迟领取养老金的价值。但这种影响的程度不足以改变他们的最佳领取年龄，除非他们持有极端的死亡主观预期。因此，我们得出结论，仅凭死亡的主观预期无法解释提前领取养老金行为的普遍性。

Intergenerational transfers in China: What are thepatterns of the transfers and when do the transfers occur?

Abstract: China'ssocial safety net is still underdeveloped, hence family support in the form ofintergenerational transfers often serves as a substitute for the publictransfer system. Using data from the China Health and Retirement LongitudinalStudy, this paper finds that both upstream inter-vivos transfers (from childrento parents) and downstream inter-vivos transfers (from parents to children) areprevalent in urban China. Moreover, the relative income status of the parentand children has an impact on inter-vivos transfers. To investigate whateconomic factors generate the observed patterns of inter-vivos transfers, thispaper adopts a general equilibrium life-cycle model in which overlappinggenerations are altruistically linked and calibrates the model to match datafrom urban China. Counterfactual experiments of removing one source of economicrisk or modifying the social security replacement rate from the baseline modelat a time reveal that intergenerational transfers mainly serve as informal insuranceagainst the income risk of the children.

中国的家庭代际转移：模式如何及何时发生？

摘要：中国的社会安全网尚不发达，因此以代际转移为形式的家庭支持往往成为公共转移支付制度的替代品。本文利用 "中国健康与退休纵向研究"（China Health and Retirement Longitudinal Study）的数据发现，上行生前财产转移（从子女到父母）和下行生前财产转移（从父母到子女）在中国城市都很普遍。此外，父母和子女的相对收入状况对生前财产转移也有影响。为了研究是哪些经济因素导致了所观察到的生前财产转移转移模式，本文采用了一个重叠的世代利他地联系在一起的一般均衡生命周期模型，并对模型进行了校准以匹配中国城市的数据。每次从基线模型中剔除一个经济风险来源或修改社会保障替代率进行的反事实实验表明，家庭代际转移主要作为非正式保险来防范子女的收入风险。

Fertility decisions and the norm of intergenerationalsupport to aging parents

Abstract: This paperexamines the impact of the social norm of intergenerational support to agingparents on fertility decisions in developing economies. The traditionalexpectation of receiving support from adult children in old age hashistorically been a significant factor in the decision to have children,especially in developing countries. The study develops a life cycle model thatendogenizes fertility choices and incorporates the expectation of transfersfrom children based on the filial responsibility norm. We utilize householdsurvey data from Indonesia to estimate earnings profiles and uncertainties overthe life cycle, and to estimate the transfers from adult children to parents toindicate the current strength of the norm in 2000s. We conducted counterfactualexperiments to explore the impact of the filial responsibility norm onfertility and found that a weakening of the norm could account for asignificant proportion of the decline in the total fertility rate.

生育决定和对年迈父母的代际支持规范

摘要：本文探讨了对年迈父母代际赡养的社会规范对发展中经济体生育决定的影响。传统上，人们期望在年老时得到成年子女的赡养，这历来是影响生育决定的一个重要因素，在发展中国家尤其如此。本研究建立了一个生命周期模型，该模型将生育选择内生化，并纳入了基于孝道责任规范的子女财产转移预期。我们利用印度尼西亚的家庭调查数据来估算生命周期中的收入状况和不确定性，并估算成年子女对父母的财产转移，以表明 2000 年代孝道规范的当前强度。我们进行了反事实实验，以探讨孝道责任规范对生育率的影响，结果发现，孝道责任规范的弱化可能是总生育率下降的重要原因。

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关键词：人口老龄化 医疗保健 宏观经济 老龄化 Longitudinal ISE