SSI for the Aged and the Problem of 'Take-Up'

The Supplemental Security Income (SSI) program provides an income and health care safety net for the elderly poor. The phenomenon of apparently eligible households that do not enroll in, or 'take up' SSI has been noted as a severe problem since the program's inception in 1974. This paper examines SSI eligibility, applications, and participation in the aged population from 1984 (the most recent year analyzed in the literature to date) through 1997. We are fortunate to have administrative data on SSI use that is linked to various panels of the SIPP. We use this information to estimate the SSI-aged application choice. The key findings from the earlier literature are sensitive with respect to exact sample specification, alternative approaches to imputing the expected SSI benefit, and more detailed information on application and receipt culled from administrative files. Our findings suggest that cash benefits may be less influential, and Medicaid access through SSI more influential, than previously estimated.

Unexplained Gaps and Oaxaca-Blinder Decompositions

We analyze four methods to measure unexplained gaps in mean outcomes: three decompositions based on the seminal work of Oaxaca (1973) and Blinder (1973) and an approach involving a seemingly naïve regression that includes a group indicator variable. Our analysis yields two principal findings. We show that the coefficient on a group indicator variable from an OLS regression is an attractive approach for obtaining a single measure of the unexplained gap. We also show that a commonly-used pooling decomposition systematically overstates the contribution of observable characteristics to mean outcome differences when compared to OLS regression, therefore understating unexplained differences. We then provide three empirical examples that explore the practical importance of our analytic results.discrimination, decompositions

An Evaluation of Instrumental Variable Strategies for Estimating the Effects of Catholic Schools

Several previous studies have relied on religious affiliation and the proximity to Catholic schools as exogenous sources of variation for identifying the effect of Catholic schooling on a wide variety of outcomes. Using three separate approaches, we examine the validity of these instrumental variables. We find that none of the candidate instruments is a useful source of identification of the Catholic school effect, at least in currently available data sets

Subjective Survival Probabilities in the Health and Retirement Study: Systematic Biases and Predictive Validity

Recent research has demonstrated that retirement planning and well-being are closely tied to probabilistic forecasts about future events. Using longitudinal data from the Health and Retirement Study, I show that individuals’ subjective survival forecasts exhibit systematic biases relative to life table data. In particular, many respondents fail to account for increases in yearly mortality rates with age, both longitudinally and in crosssection. Additionally, successive cohorts of the near elderly do not appear to revise survival forecasts to match increases in longevity. Forecasting bias may merely be due to the framing of questions designed to elicit expectations, but real biases may result in suboptimal savings rates and timing of retirement. Cross-sectional variation in subjective survival forecasts also appears to reflect differences in cognitive ability across respondents, suggesting that subjective information is more relevant for some individuals than others. Despite these shortcomings, subjective mortality probabilities predict actual mortality and portfolio choice, and they contain information not found in selfreported health status or objective measures of health limitations.Social Security Administrationhttp://deepblue.lib.umich.edu/bitstream/2027.42/57572/1/wp159.pd

Public Health Insurance and SSI Program Participation Among the Aged.

Previous researchers have noted that the ‘categorical’ Medicaid eligibility accompanying the welfare programs Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) often far exceeds the value of these programs’ cash benefits. It may be the case that the accompanying health insurance, not the cash benefit, is often the decisive factor in welfare participation. If so, welfare participation should decrease when cash and health insurance benefits are unbundled. We present a simple model of program participation with heterogeneous valuation of health insurance and transaction costs of participation. We evaluate the following four implications of the model: 1) SSI participation declines with the expansion of alternative routes to Medicaid (i.e., noncategorical Medicaid); 2) the availability of noncategorical Medicaid increases Medicaid participation among SSI nonparticipating eligibles; 3) the average SSI benefit collected by welfare recipients is higher when noncategorical Medicaid is available; and 4) the average SSI benefit rejected by nonparticipating SSI eligibles is higher when noncategorical Medicaid is available. Overall, the findings on the model’s testable implications are mixed. The estimates imply strikingly large effects of the presence of alternative routes to Medicaid on both SSI and Medicaid participation, but the results for the hypotheses about SSI benefit amounts are sensitive to controls for recipient characteristics.Social Security Administrationhttp://deepblue.lib.umich.edu/bitstream/2027.42/49423/1/wp117.pd

A Longitudinal Analysis of Entries and Exits of the Low-Income Elderly to and from the Supplemental Security Income Program

This paper is the first to analyze eligibility and participation spells and estimate dynamic models of SSI participation by the aged. We first describe eligibility and participation spells and estimate competing-risk models of the determinants of transitions. Next, we present evidence of extensive measurement error in the expected SSI benefit and the associated imputed eligibility status of sample members. We compare and contrast two approaches to ameliorating this error. A cross-section approach exploits self-reports of participants’ benefits, and a longitudinal approach makes inferences from time variation in the computed benefit. We find that the hazard model estimates vary little with regard to whether or which particular measurement error correction is employed. Finally, the longitudinal patterns of eligibility and participation suggest that take-up rates among the persistently eligible are nearly 80 percent.Social Security Administrationhttp://deepblue.lib.umich.edu/bitstream/2027.42/57568/1/wp156.pd

Kindergarten Entrance Age and Children’s Achievement

Using data from two cohorts of students, we present evidence that children who are relatively old when they enter kindergarten score higher on achievement tests and are less likely to repeat grades or suffer from learning disabilities than their younger classmates. These differences are driven by the accumulation of skill prior to school entry. The test score effects appear during the first few months of kindergarten, before much learning has taken place in school, and are especially pronounced among children from upper-income families. We do not find that the relationship between entrance age and outcomes reflects a heightened ability to learn or greater physical maturity among older children, the most common interpretations of the entrance age effect. The evidence also shows that having older classmates improves a child’s test scores but increases the probability of grade repetition and learning disability diagnoses. 2 I

Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools

We develop estimation methods that use the amount of selection on the observables in a model as a guide to the amount of selection on the unobservables. We show that if the observed variables are a random subset of a large number of factors that influence the endogenous variable and the outcome of interest, then the relationship between the index of observables that determines the endogenous variable and the index that determines the outcome will be the same as the relationship between the indices of unobservables that determine the two variables. In some circumstances this fact may be used to identify the effect of the endogenous variable. We also propose an informal way to assess selectivity bias based on measuring the ratio of selection on unobservables to selection on observables that would be required if one is to attribute the entire effect of the endogenous variable to selection bias. We use our methods to estimate the effect of attending a Catholic high school on a variety of outcomes. Our main conclusion is that Catholic high schools substantially increase the probability of graduating from high school and, more tentatively, college attendance. We do not find much evidence for an effect on test scores.

Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department

Introduction: Femoral neck fractures are a common and painful injury. Femoral nerve blocks, and a variant of this technique termed the ‘3-in-1’ block, are often used in this patient group, but their effect is variable. The fascia iliaca compartment block (FIB) has been proposed as an alternative, but the relative effectiveness of the two techniques in the early stages of care is unknown. We therefore compared the FIB versus the 3-in-1 block in a randomised trial conducted in two UK emergency departments. Methods: Parallel, two-group randomised equivalence trial. Consenting patients >18 years with a femoral neck fracture were randomly allocated to receive either a FIB or a 3-in-1 block. The primary outcome was pain measured on a 100 mm visual analogue scale at 60 min. The between-group difference was adjusted for centre, age, sex, fracture type, pre-block analgesia and pre-block pain score. Results: 178 patients were randomised and 162 included in the primary analysis. The mean 100 mm visual analogue pain scale score at 60 min was 38 mm in the FIB arm and 35 mm in the 3-in-1 arm. The adjusted difference between the arms was 3 mm, with a 95% CI (−4.7 to 10.8) that excluded a clinically important difference between the two interventions. Conclusions: FIB is equivalent to the 3-in-1 block for immediate pain relief in adult neck of femur fractures