Department of Medical Ethics and Health Policy

Document Type

Journal Article

Date of this Version


Publication Source

Health Economics


24 Suppl 1

Start Page


Last Page





While it has long been assumed that family structure and potential sources of informal care play a large role in the purchase decisions for long-term care insurance (LTCI), current empirical evidence is inconclusive. Our study examines the relationship between family structure and LTCI purchase and addresses several major limitations of the prior literature by using a long panel of data and considering modern family relationships, such as the presence of stepchildren. We find that family structure characteristics from one's own generation, particularly about one's spouse, are associated with purchase, but that few family structure attributes from the younger generation have an influence. Family factors that may indicate future caregiver supply are negatively associated with purchase: having a coresidential child, signaling close proximity, and having a currently working spouse, signaling a healthy and able spouse, that long-term care planning has not occurred yet or that there is less need for asset protection afforded by LTCI. Dynamic factors, such as increasing wealth or turning 65, are associated with higher likelihood of LTCI purchase.

Copyright/Permission Statement

This is the peer reviewed version of the following article: Van Houtven, Courtney Harold, Coe, Norma B., Konetzka, R. Tamara. (2015). Family Structure and Long-Term Care Insurance Purchase. Health Economics, 24(), 58-73. DOI: 10.1002/hec.3145., which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.


Aged, Aged, 80 and over, Family, Family Relations, Female, Humans, Income, Insurance, Long-Term Care, Male, Marital Status, Middle Aged, Models, Theoretical, Parents, United States



Date Posted: 07 October 2019