The Role of Health Insurance in Joint Retirement among Married Couples

This paper examines the role of employer provided health insurance in the retirement decisions of dual working couples. The near elderly have high-expected medical expenditures; therefore, availability of health insurance is an important factor in their retirement decisions. We determine if access to retiree health insurance for early retirement enables couples to time their retirement together – a behavior called “joint retirement.” We find that wives’ retiree health insurance more than doubles the propensity to retire jointly, suggesting that health insurance is an important consideration in coordinating retirement decisions among couples. Even though retiree health insurance has a substantial effect on joint retirement, its effect on overall employment patterns is modest, accounting for a 2 percentage point fall in employment.Retirement, health insurance

Individuals' Use of Care While Uninsured: Effects of Time Since Episode Inception and Episode Length

Few studies have addressed how use of care may vary over the course of an episode of being uninsured or across uninsured episodes of varying duration. This research models the probability that an uninsured individual has (a) any medical expenditures or charges, and (b) any office-based visit during each month of an uninsured episode. We find that the ultimate length of an individual's episode of being uninsured bears relatively little on individuals' use of healthcare in any particular month and that the probability of health care utilization rises during the first year of the episode, with more use in the second six months of the year compared to the first six months.

Health Insurance Transitions After Retirement - Did HIPAA Expand Coverage for Retirees?

The near elderly are a vulnerable segment of the population with high-expected medical expenses. Individuals who retire before Medicare eligibility may lose employer provided health insurance, and may face a potentially costly uninsured period. We use data from the Health and Retirement Study from 1992 to 2002 to profile the insurance status of workers who retire. We also evaluate the role of the Health Insurance Portability and Accountability Act (HIPAA) in reducing the number of uninsured among the near elderly. We find that a relatively small proportion of workers lose health insurance on retirement; however, we find no evidence that HIPAA has helped these workers to remain insured.

Overweight in Adolescents: Implications for Health Expenditures

We consider two compelling research questions raised by the increased prevalence of overweight among adolescents. First, what factors explain variation in adolescent bodyweight and the likelihood of being overweight? Next, do overweight adolescents incur greater health care expenditures compared to those of normal weight? We address the former question by examining the contribution of individual characteristics, economic factors, parental and family attributes, and neighborhood characteristics to variation in these bodyweight outcomes. For the second question, we estimate a two-part, generalized linear model of health spending. Using data from the Medical Expenditure Panel Survey, our econometric analyses indicate that adolescent bodyweight and the likelihood of being overweight are strongly associated with parental bodyweight, parental education, parental smoking behavior, and neighborhood attributes such as the availability of fresh food markets and convenience/snack food outlets, and neighborhood safety and material deprivation. Our expenditure model indicates that overweight females have annual expenditures that exceed those of normal weight by nearly $800 with part of the disparity explained by differences in mental health expenditures. We use both sets of empirical results to draw implications for policies to address adolescent overweight.

The Health Effects of Medicare for the Near-Elderly Uninsured

We study how the trajectory of health for the near-elderly uninsured changes upon enrolling into Medicare at the age of 65. We find that Medicare increases the probability of the previously uninsured having excellent or very good health, decreases their probability of being in good health, and has no discernable effects at lower health levels. Surprisingly, we found Medicare had a similar effect on health for the previously insured. This suggests that Medicare helps the relatively healthy 65 year olds, but does little for those who are already in declining health once they reach the age of 65. The improvement in health between the uninsured and insured were not statistically different from each other. The stability of insurance coverage afforded by Medicare may be the source of the health benefit suggesting that universal coverage at other ages may have similar health effects.

Socioeconomic Status and Medical Care Expenditures in Medicare Managed Care

This study examined the effects of education, income, and wealth on medical care expenditures in two Medicare managed care plans. The study also sought to elucidate the pathways through which socioeconomic status (SES) affects expenditures, including preferences for health and medical care and ability to navigate the managed care system. We modeled the effect of SES on medical care expenditures using Generalized Linear Models, estimating separate models for each component of medical expenditures: inpatient, outpatient, physician, and other expenditures. We found that education, income, and wealth all affected medical care expenditures, although the effects of these variables differed across expenditure categories. Moreover, the effects of these SES variables were much smaller than the effects found in earlier studies of fee-for-service Medicare. The pathway variables also were associated with expenditures. Accounting for the pathways through which SES affects expenditures narrowed the effect of SES on expenditures; however, the change in the estimates was very small. Thus, although our measures of preferences and ability to navigate the system were associated with expenditures, they did not account for an appreciable share of the impact of SES on expenditures.

Discharge Age and Weight for Very Preterm Infants in Six Countries: 2012-2020

BACKGROUND Postmenstrual age for surviving infants without congenital anomalies born at 24-29 weeks' gestational age from 2005 to 2018 in the USA increased 8 days, discharge weight increased 316 grams, and median discharge weight z-score increased 0.19 standard units. We asked whether increases were observed in other countries. METHODS We evaluated postmenstrual age, weight, and weight z-score at discharge of surviving infants without congenital anomalies born at 24-29 weeks' gestational age admitted to Vermont Oxford Network member hospitals in Austria, Ireland, Italy, Switzerland, the UK, and the USA from 2012 to 2020. RESULTS After adjustment, the median postmenstrual age at discharge increased significantly in Austria (3.6 days, 99% CI [1.0, 6.3]), Italy (4.0 days [2.3, 5.6]), and the USA (5.4 days [5.0, 5.8]). Median discharge weight increased significantly in Austria (181 grams, 99% CI [95, 267]), Ireland (234 [143, 325]), Italy (133 [83, 182]), and the USA (207 [194, 220]). Median discharge weight z-score increased in Ireland (0.24 standard units, 99% CI [0.12, 0.36]) and the USA (0.15 [0.13, 0.16]). Discharge on human milk increased in Italy, Switzerland, and the UK, while going home on cardiorespiratory monitors decreased in Austria, Ireland, and USA and going home on oxygen decreased in Ireland. CONCLUSIONS In this international cohort of neonatal intensive care units, postmenstrual discharge age and weight increased in some, but not all, countries. Processes of care at discharge did not change in conjunction with age and weight increases

Discharge age and weight for very preterm infants in six countries: 2012-2020

Postmenstrual age for surviving infants without congenital anomalies born at 24-29 weeks' gestational age from 2005 to 2018 in the USA increased 8 days, discharge weight increased 316 grams, and median discharge weight z-score increased 0.19 standard units. We asked whether increases were observed in other countries. We evaluated postmenstrual age, weight, and weight z-score at discharge of surviving infants without congenital anomalies born at 24-29 weeks' gestational age admitted to Vermont Oxford Network member hospitals in Austria, Ireland, Italy, Switzerland, the UK, and the USA from 2012 to 2020. After adjustment, the median postmenstrual age at discharge increased significantly in Austria (3.6 days, 99% CI [1.0, 6.3]), Italy (4.0 days [2.3, 5.6]), and the USA (5.4 days [5.0, 5.8]). Median discharge weight increased significantly in Austria (181 grams, 99% CI [95, 267]), Ireland (234 [143, 325]), Italy (133 [83, 182]), and the USA (207 [194, 220]). Median discharge weight z-score increased in Ireland (0.24 standard units, 99% CI [0.12, 0.36]) and the USA (0.15 [0.13, 0.16]). Discharge on human milk increased in Italy, Switzerland, and the UK, while going home on cardiorespiratory monitors decreased in Austria, Ireland, and USA and going home on oxygen decreased in Ireland. In this international cohort of neonatal intensive care units, postmenstrual discharge age and weight increased in some, but not all, countries. Processes of care at discharge did not change in conjunction with age and weight increases

Retiree Health Benefit Coverage and Retirement

Employer-provided health benefits for workers who retire before age 65 has fallen over the last decade. We examine a cohort of male workers from the Health and Retirement Survey to explore the dynamics of retiree health benefits and the relationship between retiree health benefits and retirement behavior. A better understanding of this relationship is important to the policy debate over the best way to increase health coverage for older Americans without reducing work incentives. Concerning the dynamics at work, we find that, between 1992 and 1996, 24 percent of full-time workers who had retiree health benefits lost their coverage, while 15 percent of full-time workers who lacked coverage gained it. Also, of the full-time employed men who were covered by retiree health benefits in 1992 and had retired by 1996, 3 percent were uninsured, and 15 percent were covered by health insurance other than employer-provided insurance. On the relationship between retiree health benefits and retirement, we find that workers with retiree benefits were 29 to 55 percent more likely to retire than those without. We also find that workers who are eligible for retiree health benefits tend to take advantage of them when they are relatively young

Health insurance transitions after retirement : did HIPAA expand coverage for retirees?

The near elderly are a vulnerable segment of the population with high-expected medical expenses. Individuals who retire before Medicare eligibility may lose employer provided health insurance, and may face a potentially costly uninsured period. We use data from the Health and Retirement Study from 1992 to 2002 to profile the insurance status of workers who retire. We also evaluate the role of the Health Insurance Portability and Accountability Act (HIPAA) in reducing the number of uninsured among the near elderly. We find that a relatively small proportion of workers lose health insurance on retirement; however, we find no evidence that HIPAA has helped these workers to remain insured