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Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.

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Given the aging of the population, policies relating to the design and reform of public pension programs are prominent in policy debates. For many developing countries, a major concern centers around the possible displacement of traditional family-based support by public programs. One challenge in estimating this displacement, or crowding out, is the endogeneity of social security benefits-the incidence and size of benefits may be correlated with unobserved determinants of private transfers, especially if benefits are means tested. Using two rich data sets, this article explores the impact of the Taiwanese Farmers' Pension Program (FPP) on recipients and their noncohabiting adult children. The FPP is targeted at elderly farmers and has relatively clean, exogenous rules for eligibility that allow the endogeneity problem to be addressed. Estimates from multiple identification strategies consistently imply that 1 dollar of pension crowds out 30-39 cents of private transfers received by the elderly. Mirroring these results, the pension also reduces the probability that the recipients' children make transfers to their parents. Further, the pension increases both the recipients' and their children's consumption, thus providing direct evidence of an improvement in the well-being of pensioners' offspring. (c) 2010 by The University of Chicago. All rights reserved..