Sanidad, Dependencia y Pensiones

Documentos Sanidad, Dependencia y Pensiones

Proyecciones financieras y de bienestar del sistema español de pensiones: resultados de simulación

eee2017-15 | Alfonso R. Sánchez, 12/06/2017

Las próximas décadas supondrán un auténtico desafío para la economía española. El horizonte se presenta cargado de incertidumbres que se extienden desde los fundamentos técnicos y organizativos de la economía hasta sus formas institucionales y políticas. Estas tensiones tienen como telón de fondo dos procesos demográficos simultáneos: el aumento secular en la esperanza de vida y la jubilación de las cohortes de “Baby-boomers”. El primero de los procesos es progresivo e irresistible, empujando poco a poco a las economías a la realidad del envejecimiento generalizado. El segundo proceso generar ́a cambios muy importantes y relativamente rápidos en la composición por edades de la población. Dejará sentir sus efectos en la dotación de factores productivos, el crecimiento y todos los aspectos relacionados con los flujos de trasferencia entre generaciones. Entre ellos, el saldo financiero del sistema público de pensiones es el m ́as evidente y el que constituye el centro de atención de este trabajo.

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Great Recession and Disability Insurance in Spain

dt2017-08 | Sergi Jiménez-Martín, Arnau Juanmarti Mestres, Judit Vall Castelló, 05/06/2017

In this paper, we exploit the strong incidence of the Great Recession in Spain to estimate the effect of economic conditions on participation in Disability Insurance (DI). Using individual panel data, we show that increases in the local unemployment rate are associated with a reduction in the individual probability to enter the DI program during the Great Recession in Spain. Using aggregate data on applications, we show that this procyclical behavior of DI awards comes from an increase in the proportion of applications that are denied. Thus, contrary to the previous literature that has extensively reported a countercyclical behavior of DI participation, our results provide new evidence that, in periods of extremely recessionary conditions, DI participation may turn procyclical.

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Hiring subsidies for people with disabilities: Do they work?

fpp2017-11 | Sergi Jiménez-Martín, Arnau Juanmarti Mestres, Judit Vall Castelló, 03/05/2017

This article evaluates the effectiveness of hiring subsidies targeted to people with disabilities. By exploiting the timing of implementation among the different Spanish regions of a subsidy scheme implemented in Spain during the period 1990-2014, we employ a differencesin-differences approach to estimate the impact of the scheme on the probability of DI beneficiaries of transiting to employment and on the propensity of individuals of entering the DI program.

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La salud financiera del sistema público de pensiones español. Análisis retrospectivo, proyecciones de largo plazo y factores de riesgo

eee2017-04 | Ángel de la Fuente, Miguel Ángel García Díaz, Alfonso R. Sánchez, 20/02/2017

En el presente informe se analiza la evolución de las cuentas del sistema público de pensiones contributivas durante las tres últimas décadas y se construyen proyecciones de largo plazo de sus gastos e ingresos bajo diversos escenarios macroeconómicos y distintas opciones de política

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Proyecciones financieras y de bienestar del sistema español de pensiones: modelización en equilibrio general

eee2017-03 | Alfonso R. Sánchez, 16/02/2017

Este documento presenta los detalles de formulación y calibración de un modelo de equilibrio general dinámico de generaciones solapadas de gran escala de la economía española. El modelo está diseñado para generar proyecciones coherentes del comportamiento de los agregados macroeconómicos y de pensiones, así como del bienestar de las distintas generaciones, sobre un horizonte temporal muy dilatado (hasta 2070). Se revisan los cambios introducidos respecto de la última versión existente del modelo (Sánchez-Martín (2014)) y se discuten posibles mejoras futuras.

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Should pensions be redistributive? The impact of Spanish reforms on the system’s sustainability and adequacy

dt2017-02 | Concepció Patxot, Meritxell Solé, Guadalupe Souto, 02/02/2017

Concerns about the consequences of demographic ageing on the sustainability of the pension system has led to the adoption of reforms reducing pension expenditure. However, the impact of these reforms on pension adequacy is now coming under increasing scrutiny. Taking recent Spanish reforms as an example, this paper analyses the extent to which fostering pension sustainability threatens pension adequacy, with a particular focus on inter- and intragenerational equity. Using an extension of the DyPeS microsimulation model, results show that the introduction of mechanisms linking retirement pensions to the evolution of the social security budget balance has strong and negative effects on adequacy and on income redistribution. Unexpected effects of the Bismarckian reforms on income redistribution are also observed. The outcomes reported for the Spanish pension system highlight the need to reconsider the convenience of using the pension system as an income redistribution device.

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Medidas para restaurar (o no) la sostenibilidad financiera de las pensiones

fpp2017-04 | J. Ignacio Conde-Ruiz, 23/01/2017

En el presente trabajo se revisan algunas propuestas frecuentemente ofrecidas como solución al problema de la sostenibilidad financiera de nuestro sistema de pensiones. El autor concluye que ninguna de estas medidas puede evitar que la generosidad del sistema de pensiones se reduzca significativamente en el futuro y defiende la adopción de un modelo de cuentas nacionales como forma más equitativa de asegurar la sostenibilidad del sistema.

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Segundo Informe del Observatorio de Sanidad Fedea

eee2016-30 | Sergi Jiménez-Martín, Analía Viola, 04/10/2016

Tras la fuerte expansión del gasto sanitario registrada entre 2000 y 2009, hemos asistido desde 2010 a una fuerte contracción de los recursos destinados al sistema sanitario español. Según los últimos datos disponibles, entre 2011 y 2014 las comunidades autónomas redujeron su gasto en sanidad en algo más del 6% en términos nominales y en torno al 10% en términos reales. Afortunadamente, en los dos últimos años los presupuestos iniciales en sanidad de las comunidades autónomas mostraron una leve mejoría, con un aumento global del 3% en 2015 y del 5% en 2016 en relación al año anterior.

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Thinking of Incentivizing Care? The Effect of Demand Subsidies on Informal Caregiving and Intergenerational Transfers

dt2016-08 | Joan Costa-Font, Sergi Jiménez Martín, Cristina Vilaplana, 21/09/2016

We still know little about what motivates the informal care arrangements provided in old age. Evidence from demand-side subsidies such as unconditional caregiving allowances (cash benefits designed either to incentivize the purchase of care, or compensate for the loss of employment of informal caregivers) provide an opportunity to gain a further understanding of the matter. We exploit a quasi-natural experiment to identify the effects of the inception in 2007 (and reduction in 2012) of a universal caregiving allowance on the supply of informal care, and subsequent intergenerational transfer flows. We find evidence of a 30% rise in informal caregiving, which amounts to 27% of long-term care expenditure, and an increase (reduction) in downstream (upstream) intergenerational transfers of 29% (and 15%). The effects were attenuated by a subsequent policy intervention; the reduction of the subsidy amidst austerity cuts in 2012. Individuals in middle and lower income and wealthy quintiles mainly drive these effects.

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The effects of non-adherence on health care utilisation: panel data evidence on uncontrolled diabetes

dt2016-06 | Joan Gil, Antonio Sicras-Mainar, Eugenio Zucchelli, 04/09/2016

Despite size and relevance of non-adherence to health treatments, robust evidence on its effects on health care utilisation is very limited. We focus on non-adherence to diabetes treatments, a widespread problem, and employ longitudinal administrative data from Spain (2004-2010) to identify and quantify the effects of uncontrolled type 2 diabetes on health care utilisation. We use a biomarker (glycated haemoglobin, HbA1c) to detect the presence of uncontrolled diabetes and explore its effects on both primary and secondary health care. We estimate a range of panel count data models, including negative binomials with random effects, dynamic and hurdle specifications to account for unobserved heterogeneity, previous utilisation and selection. We find uncontrolled diabetes in around 30% of patients of both genders. Although women appear to systematically consume more health care compared to men, their consumption levels do not appear to be influenced by uncontrolled diabetes. Conversely, among men uncontrolled diabetes increases the average number of GP visits per year by around 4%, specialist visits by 4.4% and greatly extends hospital length of stay.

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Does Long-Term Care Subsidisation Reduce Unnecessary Hospitalisations?

dt2016-05 | Joan Costa-Font, Sergi Jiménez Martín, Cristina Vilaplana, 26/07/2016

The expansion of long-term care (LTC) coverage may improve health system efficiency by reducing hospitalisations (bed-blocking), and pave the way for the implementation of health and social care coordination plans. We draw upon the quasiexperimental evidence from the main expansion of long term care increase subsidisation in Spain in 2007 to examine the causal effect of the expansion of LTC subsidisation and coordination on hospitalisations (both on the internal and external margin) and the hospital length of stay. In addition, we examine the 2012 austerity budget cuts that reduced the subsidy. We find robust evidence of a reduction in hospitalisations and the length of stay after the expansion of LTC subsidisation. However, the reduction in hospitalisations is heterogeneous to the existence of health and social care coordination plans and type of subsidy. Overall, we estimate savings related to hospitalisations of up to 11% of total hospital costs. Consistently, subsidy reduction is found to attenuate bed-blocking gains

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Estimating a cost-effectiveness threshold for the Spanish NHS

eee2016-22 | Laura Vallejo-Torres, Borja García-Lorenzo, Pedro Serrano-Aguilar, 21/06/2016

The mean cost of an additional Quality-Adjusted Life Year (QALY) within a National Health Service (NHS) reveals how much health is lost, on average, when services currently provided by the NHS are displaced. This value has been suggested as a proxy of the average opportunity cost required to set a cost-effectiveness threshold when facing fixed budget constraints. In this paper, we generate information on the marginal cost per QALY in the Spanish NHS that can be used to inform a cost-effectiveness threshold using a pannel of quinquennial data for the 17 regional health services.

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“Cultural Persistence” of Health Capital: Evidence from European Migrants

dt2016-04 | Joan Costa-Font, Azusa Sato, 13/06/2016

El efecto de la cultural sanitaria sobre la producción de salud, y más concretamente el capital sanitaria, es una cuestión poco estudiada pero de elevada importancia. La salud depende de decisiones individuales que pueden estar altamente motivadas por valores sociales que son específicos del grupo cultural al que pertenece cada individuo. Este trabajo es el primero en analizar empíricamente la persistencia cultural del capital sanitario. Específicamente, en este artículo examinamos la persistencia entre la salud auto reportada del individuo que clasificamos como inmigrante de primera y segunda generación (en treinta países europeos de la muestra), con las salud auto reportada media de sus países de origen (más de 91 países del mundo).

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Like Mother, Like Father? Gender Assortative Transmission Of Child Overweight

dt2016-03 | Joan Costa-Font, Mireia Jofre i Bonet, 29/05/2016

Una de las principales explicaciones del aumento de la obesidad y el sobrepeso infantil está en la transmisión de estilos de vida poco saludables por parte de los padres. En el presente trabajo se contrasta esta hipótesis utilizando una base de datos única y representativa que recoge información anual desde 1996 a 2009 sobre el paso y la altura de padres e hijos en Inglaterra.

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Is Marriage Protecting your Health in Recession Times?

eee2016-19 | Joan Gil, 16/05/2016

Este artículo tiene como objetivo estudiar si el “efecto protector” del matrimonio en la salud de los individuos sigue siendo válido en tiempos de recesión económica. El análisis empírico que seguimos consta de dos etapas y está basado en datos individuales de corte transversal (Encuesta Nacional de Salud de España). En primer lugar se estima el impacto causal del divorcio y la separación legal (disolución marital) sobre la salud mental y el consumo excesivo de alcohol por medio de emplear técnicas de “propensity score matching” en dos momentos distintos del tiempo: antes y después (durante) la crisis económica. En segundo lugar, se analiza si existe un efecto incremental (reductor) sobre estos indicadores de salud derivados de la recesión económica por medio de emplear métodos de regresión de diferencias en diferencias (DiD), condicionando estas estimaciones vía una proxy de estado de salud inicial.

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From Bismarck to Beveridge: the Other Pension Reform in Spain

eee2016-16 | J. Ignacio Conde-Ruiz, Clara I. González, 17/04/2016

Ageing is the major challenge for the PAYG pension systems in developed countries. Most of them are undergoing reforms in order to adapt to the new demographic reality. The package of reforms implemented includes increasing the retirement age, reducing the replacement rate, or introducing a sustainability factor linking pension to life expectancy. The aim of this paper is to analyse the potential consequences of a different type of reform that is at a very incipient stage in Spain but that could have a significant impact if it were fully implemented. This reform, called ‘silent reform’ because it is imperceptible to citizens in its early stages, basically consists in increasing maximum pensions in line with inflation instead of wage or productivity growth. This policy is reducing the replacement rate only for high earning workers and increasing the redistributive component of the system. This paper is the first to quantify and evaluate the potential consequences of this type of reform in Spain. We have used an accounting model with heterogeneous agents and overlapping generations in order to project pension expenditure for the next five decades. The results show that this type of reform could potentially contain future expenditure but at the cost of changing the nature of the pension system from a contributory or Bismarckian-type system into a pure redistributive pension system or Beveridgean-type one. The paper also shows that the institutional characteristics (i.e. the existence of maximum limits to pensions and contributions) that make this kind of reform possible are also present in the majority of developed countries with Bismarckian pension systems. Therefore, the lessons learned in this paper could be useful to other countries.

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Copagos sanitarios. Revisión de experiencias internacionales y propuestas de diseño

fpp2016-04 | Beatriz Gonzalez Lopez-Valcarcel, Jaume Puig-Junoy, Santiago Rodriguez Feijoó, 25/02/2016

La participación de los pacientes en el coste de los bienes y servicios sanitarios es una práctica habitual en todos los sistemas sanitarios, tanto en seguros privados como en sistemas nacionales de salud universales. Su justificación se basa en el riesgo moral inducido por el exceso de consumo cuando el precio pagado por el consumidor es inferior al valor o utilidad marginal.
Los copagos se suelen imponer a los diferentes servicios de atención médica (visitas médicas, pruebas diagnósticas, intervenciones quirúrgicas, urgencias, hospitalizaciones) y a los medicamentos y demás insumos. Hay una amplia variedad de diseños en la forma, alcance, y exenciones. Los copagos afectan al consumo de los servicios por los que se paga, tienen efectos cruzados sobre otros servicios médicos, sobre la renta disponible y la equidad, y sobre la salud de las personas y poblaciones.

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Health Capacity to Work at Older Ages: Evidence from Spain

dt2016-02 | Pilar García Gómez, Sergi Jiménez Martín, Judit Vall Castello, 18/02/2016

Existe una gran preocupación acerca de la sostenibilidad de los sistemas de Seguridad Social debido al envejecimiento de la población en los países desarrollados, y España no es una excepción. España tiene una de las tasas de fecundidad más bajas de Europa (por debajo de 1,4, según Eurostat, 2013), a la par que una de las esperanzas de vida al nacer más altas, 82,5 años en 2012, que contrasta con una media de la UE-28 de 79,2 (OCDE, 2014). En una línea similar, la esperanza de vida a los 65 años ha ido mejorando con el tiempo: de 13,1 años adicionales en 1960 a 18,7 en 2012 (García- Gómez et al 2012 y OCDE, 2014). En paralelo al incremento de la esperanza de vida se observó una reducción de la participación de los trabajadores de edad avanzada, que solo se revirtió parcialmente entre 1995 y 2007, para volver a valores anormalmente bajos en la reciente crisis económica.

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Consumo de medicamentos y copago farmacéutico

eee2016-06 | Sergi Jiménez-Martín, Analía Viola, 10/02/2016

En este trabajo estimamos los efectos del copago en España en el consumo/acceso de medicamentos en dos colectivos, Seguridad Social y Muface, que se distinguen por su nivel de copago farmacéutico, usando datos de la Encuesta Nacional de Salud para los años 2003 a 2012. Los resultados obtenidos indican que la condición de jubilado, dependiendo de la edad de jubilación y el estado de salud, aumenta la propensión a consumir medicamentos con receta entre un 12 y 18 por ciento para los afiliados a la Seguridad Social respecto de los activos, especialmente inducido por la variación en el copago en el momento de la jubilación. Por otra parte, la condición de jubilado tiene un efecto mucho menor, no estadística diferente de cero, sobre los afiliados a Muface, cuyo régimen de copago no varía con la jubilación, especialmente para los hombres. Finalmente, encontramos una sustancial variación de los resultados según el grupo de medicamentos, que debe ser tenida en cuenta en la formulación de políticas públicas.

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Informe 2016. Observatorio de dependencia

eee2016-05 | Sergi Jiménez-Martín, Cristina Vilaplana, Analía Viola, 01/02/2016

Cuando se gestó el Sistema de Autonomía Personal y Atención a la Dependencia (SAAD) fue rápidamente etiquetado como el cuarto pilar del estado del bienestar: educación, sanidad, pensiones y, finalmente, dependencia. Sin lugar a dudas, el desarrollo y consolidación de los tres primeros pilares en la etapa democrática, aunque con ciertos altibajos, se puede cali car como de éxito. Punto y aparte merece el SAAD que se gestó en una época de bonanza económica, nació en 2007 y empezó a crecer a la par de la crisis y está en riesgo de languidecer como consecuencia de la profunda recesión de la economía española y de los severos recortes introducidos en 2012 (RD Ley 20/2012, de 13 julio) y 2013 (RD 1050/2013).

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Bad times, slimmer children?

dt-2015-10 | Cristina Belles-Obrero, Sergi Jiménez Martín, Judit Vall Castello, 21/09/2015

In this paper we study the effect of business cycle conditions on infant underweight, overweight and obesity. We exploit 8 waves (1987-2012) of the Spanish National Health Survey for children aged 2-15 and use the regional unemployment rate of the trimester of the interview as a proxy for the business cycle phase at the local level. We find that an increase in the unemployment rate is associated with lower obesity incidence, especially for children under 6 years old and over 12 years old. Negative economic shocks also increase the prevalence of infant underweight, particularly for boys under 6 years old. Moreover, we show that one of the possible mechanism through which the cycle is impacting infant obesity is the nutritional composition of the children’s diet, as well as, increases in the frequency of exercise. Although we show a deterioration in self-reported health for children under 6 years old, we provide some preliminary evidence that suggests that the impact of business cycle conditions on infant weight disorders have little objective health consequences in the short-run and do not persist in the medium-run.

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The Unintended Effects of Increasing the Legal Working Age on Family Behaviour

dt-2015-09 | Cristina Belles-Obrero, Sergi Jiménez Martín, Judit Vall Castello, 24/06/2015

We use an exogenous variation in the Spanish legal working age to investigate the effect of education on fertility and infant health. The reform introduced in 1980 raised the minimum legal age to work from 14 to 16 years old. We show that the reform increased educational attainment, which led to 1786 more women remaining childless and 3307 less children being born in the 10 generations after the reform. These negative effects operate through a postponement of first births until an age where the catching up effect cannot take place. We show that woman’s marriage market is one channel through which education impacts fertility, delaying the age at which women marry for the first time and reducing the likelihood that a woman marries. Even more importantly, this postponement in fertility seems to be also detrimental for the health of their offspring at the moment of delivery. The reform caused 2,789 more children to be born with less than 37 weeks of gestation, 268 died during the first 24 hours of life and 4,352 were born with low birth weight. We are able to document two channels that contribute to the negative effects on infant health: the postponement in age of delivery as well as a higher employment probability of more educated women, which enhances unhealthier behaviors (smoking and drinking).

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The effect of changes in the statutory minimum working age on educational, labor and health outcomes

dt-2015-07 | Sergi Jiménez-Martín, Judit Vall Castello, Elena del Rey, 01/06/2015

In this paper we explore the effects of a labor market reform that changed the statutory minimum working age in Spain in 1980. In particular, the reform raised the statutory minimum working age from 14 to 16 years old, while the minimum age for attaining compulsory education was kept at 14 until 1990. To study the effects of this change, we exploit the different incentives faced by individuals born at various times of the year before and after the reform. We show that, for individuals born at the beginning of the year, the probabilities of finishing both the compulsory and the post-compulsory education level increased after the reform. In addition, we find that the reform decreases mortality while young (16-25) for both genders while it increases mortality for middle age women (26-40). We provide evidence to proof that the latter increase is partly explained by the deterioration of the health habits of affected women. Together, these results help explain the closing age gap in life expectancy between women and men in Spain.

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A simple model of aggregate pension expenditure

dt-2014-17 | Ángel de la Fuente, 11/11/2014

This paper develops a simple model that can be used to analyze the long-term sustainability of the contributive pension system and the steady-state response of pension expenditure to changes in some key demographic and economic variables, in the characteristics of the average pensioner and in the parameters that describe how pensions are calculated in Spain as a function of workers' Social Security contribution histories.

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Reforming the U.S. Social Security system accounting for employment uncertainty

dt-2014-12 | Hugo Benítez-Silva, J. Ignacio García-Pérez, Sergi Jiménez-Martín, 07/10/2014

The discussion about the need for Social Security reforms has recently resurfaced, and is expected to continue to be part of the political agenda in the near future. Our paper is a step in the direction of providing a framework for policy analysis that accounts for employment uncertainty, something that has been relatively overlooked in terms of its link with retirement decisions. In this context, we explicitly consider the participation decision of older individuals along with their decision to claim Social Security retirement benefits, using a sequential decision structure. We have numerically solved and simulated a benchmark model of the inter-temporal decision problem that individuals face in the United States. Our results show that the model is able to explain with great accuracy the strikingly high proportion of individuals who claim benefits exactly at the Early Retirement Age. The model is also able to replicate the declining labor force participation at older ages. Additionally, we discuss a number of policy experiments that suggest that individuals claiming and labor supply decisions are responsive to measures likely to be on the table for policy makers when considering the reforms of the U.S. Social Security system.

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Delaying the normal and early retirement ages in Spain: behavioural and welfare consequences for employed and unemployed workers

dt-2014-06 | Alfonso R. Sánchez, J. Ignacio García-Pérez, Sergi Jiménez-Martín, 01/06/2014

In this paper, we explore the links between pension reform, early retirement, and the use of unemployment as an alternative pathway to retirement. We use a dynamic rational expectations model to analyze the search and retirement behaviour of employed and unemployed workers aged 50 or over. The model is calibrated to reproduce the main reemployment and retirement patterns observed between 2002 and 2008 in Spain. It is subsequently used to analyze the effects of the 2011 pension reform in Spain, characterized by two-year delays in both the early and the normal retirement ages. We find that this reform generates large increases in labour supply and sizable cuts in pension costs, but these are achieved at the expense of very large welfare losses, especially among unemployed workers. As an alternative, we propose leaving the early retirement age unchanged, but penalizing the minimum pension (reducing its generosity in parallel to the cuts imposed on individual pension benefits, and making it more actuarially fair with age). This alternative reform strikes a better balance between individual welfare and labour supply stimulus.

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The Incentive Effects of Minimum Pensions: extended version

dt-2014-04 | Sergi Jiménez-Martín, 09/05/2014

The minimum pension program is one of the key welfare programs in many developing and developed countries and a key influence in retirement of low income workers or workers with intermittent working careers. The main purpose of minimum benefits programs is to guarantee a minimum standard of living after retirement. In general minimum contributory pensions that are only made available after the normal retirement age have little (but sizeable) incentives effect in at least low incomer workers. Alternatively minimum contributory benefits made available at the early retirement age can generate substantial incentive effects on transitions to retirement of employed and unemployed workers. The importance of this effect critically depends upon both the eligibility conditions and the generosity of the minimum pension, that is, in the relationship between the guaranteed minimum pension and the average or the minimum wage.

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Sanidad, dependencia y pensiones

Coordinado por Sergi Jiménez

Esta área de investigación ha sido patrocinada parcialmente por la Cátedra CaixaBank de Economía de la Salud y Hábitos de Vida

CaixaBank

Las opiniones recogidas en estos documentos son las de sus autores y no coinciden necesariamente con las de FEDEA.