Health benefits valuation in three‐generation households—the role of reciprocity

• Published date: 01 April 2024
• Author: Anna Bartczak,Wiktor Budziński,Anna Nicińska,Natalia Starzykowska
• Date: 01 April 2024
• DOI: http://doi.org/10.1111/fare.12954

RESEARCH

Health benefits valuation in three-generation

households—the role of reciprocity

Anna Bartczak | Wiktor Budzi

nski | Anna Nici

nska |

Natalia Starzykowska

Faculty of Economic Sciences, University of

Warsaw, Warsaw, Poland

Correspondence

Anna Bartczak, Dluga 44/50 Street, 00-241,

Warsaw, Poland.

Email: bartczak@wne.uw.edu.pl

Funding information

Narodowe Centrum Nauki, Grant/Award

Number: OPUS 11, project no. 2016/21/B/

HS4/01992

Abstract

Objective: This study investigates preferences for family

resource allocation on health in three-generation families

and examines whether reciprocity attitudes influence pref-

erences and willingness to pay (WTP) for reducing lifetime

health risk.

Background: Empirical results of nonmarket valuation

studies suggest that adults value improving their children’s

health more than their own. Such results are often explained

by parental altruism, but self-interest may also be involved.

Method: A choice experiment valuation survey elicited

respondents’preferences for lifetime risk reduction in coro-

nary artery disease (CAD) and a psychometric scale assessed

their reciprocal attitudes. Respondents were middle-generation

members of three-generation households. To conduct the anal-

ysis a hybrid mixed logit model was used that enabled includ-

ing psychological factors into a utility function derived from

respondents’survey choices.

Results: Reciprocal attitudes had distinct effects on the

middle-generation preferences for reducing family mem-

bers’risk of CAD. The latent attitudes concerning reci-

procity significantly affected the WTP for the health risk

reduction for all family members. The impact of reciproc-

ity on the valuation of CAD risk reduction for the respon-

dent and the elderly parent was similar, but for the child, it

was significantly higher.

Conclusions: Parents’higher WTP for improving children’s

health, at least partially, reflects strategic decisions related

to reciprocal beliefs. Reciprocity also affects the evaluation

of health benefits for elderly parents and middle-aged

respondents themselves.

Received: 2 March 2022 Revised: 18 May 2023 Accepted: 21 June 2023

DOI: 10.1111/fare.12954

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits

use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or

adaptations are made.

© 2023 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

Family Relations. 2024;73:1121–1138. wileyonlinelibrary.com/journal/fare 1121

Implications: These findings may have implications regard-

ing the degree to which the so-called “sandwich generation”

can substitute for the government in the area of health and

social care for the elderly.

KEYWORDS

choice experiment, intergenerational transfers, nonmarket valuation,

reciprocity, three-generation household

INTRODUCTION

Understanding drivers of intergenerational transfers within the family is key to the des ign of

effective policies in health and social care. This understanding is critical for assessing the poten-

tial impact of changes in resource conditions on transfer behavior. For example, whether trans-

fers among family members are motivated by altruism or by exchange considerations can make

a difference in predicting the likely consequences of changes in financial incentives designed for

health and social care and in public transfers such as pensions (Kohli & Künemund, 2003).

Intergenerational transfers constitute a part of a broader gift-giving phenomenon. Gift

exchange can be seen as a social activity confirming relationships and social interactions.

Anthropologists such as Malinowski (1921) or Sahlins (1972) emphasized that gift exchange

plays an important role in community building. Gift-giving can be economically motivated but

can also constitute an expression of self-identity, emotions, or self-sacrificed (Hollenbeck

et al., 2006). Mutual support between generations—for example, in terms of transfers—can be

defined as intergenerational solidarity (Thijssen, 2016). The concept of solidarity derives from

sociology and includes both moral components and social interaction (Merz et al., 2007). Feel-

ings of moral obligation may lead to patterns of reciprocity in transfer exchange (Komter &

Vollebergh, 1997).

Research into reciprocity has increased significantly since the mid-20th century with

H. Becker (1956) referring to the human species as “homo reciprocus.”Kolm (2008) stated that

reciprocity is a major type of social interaction, especially in successful groups, whereas Nowak

and Sigmund (2000) described it as the evolutionary basis for cooperation in society. Reciproc-

ity and reciprocal interactions have been subject to studies carried out in various scientific disci-

plines, inter alia in sociology (see e.g., Adloff & Mau, 2006; Diekmann, 2004; Okada, 2020),

psychology (see e.g., Feldman & Masalha, 2010; Molm, 2010; Stevenson et al., 2020), demogra-

phy (see e.g., Astone et al., 1999; Logan & Spitze, 1995; Robertson, 1997), gerontology (see

e.g., G. Becker et al., 2003; Fyrand, 2010; Wentowski, 1981), biology (see e.g., Gintis, 2000;

Guala, 2012), and economics (see e.g., Fehr & Gächter, 2000; Hoffman et al., 1998; Kolm &

Ythier, 2006).

In economics, empirical research on reciprocity has mainly been carried out as lab experi-

ments (see e.g., Bolton et al. 2021; Charness et al., 2007). However, experiments concerned with

relations within households have been relatively rare. They have been mainly focused on the

economic behavior of children and adolescents or spouses/partners (see e.g., Oosterbeek

et al., 2003; Sutter, 2019), not taking into account the elderly generation. Furthermore, most of

these studies concentrated on only a single two-part direct exchange type of reciprocity, which

is the result of the optimization behavior of selfish individuals (Molm, 2010). Importantly, reci-

procity is not limited to bilateral actions. It can also take an indirect form and may lead to a

particular type of intergenerational transfer that initially occurs between two generations but

can lead to return transfers toward (or from) a third generation. A person can make a transfer

to their child because they were also given to as a child or because they expect that their action

will incentivize their child to transfer to their own children later. Kolm (2008) referred to the

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