Health Insurance and the Labor Supply Decisions of Older Workers: Evidence from a U.S. Department of Veterans Affairs Expansion

Association of occupation with the daily physical activity and sedentary behaviour of middle-aged workers in Korea: a cross-sectional study based on data from the Korea National Health and Nutrition Examination Survey

OBJECTIVES

The WHO recommends that adults engage in regular moderate-to-vigorous physical activities (MVPAs) and muscle-strengthening activities (MSA), and minimise sedentary behaviour. This study aimed to determine the association of occupation with MVPA, MSA and sedentary behaviour in middle-aged Korean workers.

DESIGN AND SETTING

A cross-sectional study using data from the seventh Korea National Health and Nutrition Examination Survey (2016-2018).

PARTICIPANTS

Workers aged between 40 and 69 years in Korea (n=6359).

OUTCOME MEASURES

Population-weighted proportions not meeting the MVPA (＜150 min/week) and MSA (＜2 days/week) guidelines, and with high sedentary behaviour (＞7 hours/day) were calculated, and their associations with sociodemographic and work-related variables were assessed using multiple logistic regression analyses. Additionally, the estimated time spent on MVPA, MSA and sedentary behaviour according to the occupation categories (white-collar, pink-collar and blue-collar) was calculated using analysis of covariance (ANCOVA).

RESULTS

The MVPA level did not show a significant difference across the occupation categories. Blue-collar workers showed significantly lower MSA participation than white-collar and pink-collar workers (male, p=0.006; female, p=0.004; by ANCOVA). High sedentary behaviour was significantly associated with white-collar occupations (p<0.001 by ANCOVA). Longer working hours were negatively associated with MVPA (OR=1.01, 95% CI 1.01 to 1.02) and MSA (OR=1.01, 95% CI 1.00 to 1.02). Workers with higher stress were less likely to participate in MSA (male: OR=1.43, 95% CI 1.10 to 1.86; female: OR=1.39, 95% CI 1.08 to 1.80). Self-employed workers showed lower MVPA levels than employees (male: OR=1.26, 95% CI 1.09 to 1.47; female: OR=1.36, 95% CI 1.13 to 1.64). Daily workers compared with full-time workers (OR=0.38, 95% CI 0.24 to 0.59) and temporary workers compared with regular workers (OR=0.75, 95% CI 0.59 to 0.95) were associated with less sedentary behaviour in men.

CONCLUSION

A number of work-related factors were associated with PA levels and sedentary behaviour in middle-aged workers. The workplace is one of the critical elements to intervene in health promotion strategies.

Influences of Public Medical Insurance System on Labor Health Status and Supply

BACKGROUND

The emergence of COVID-19 in 2020 has brought dramatic impacts to the global economy. The resulting health crisis and widespread fear have triggered labor shortage problems such as high job vacancy rate and low labor participation rate. Thus, how to increase the labor supply has become a hotspot among scholars. We aimed to analyze the influences of public medical insurance system on labor health status and supply.

METHOD

Using the China Health and Nutrition Survey five-phase panel data, the new rural cooperative medical system was taken as an example to empirically analyze the influences of public medical insurance system on the individual health status and labor supply via the panel Tobit model and panel binary Logit model. The analysis revealed the mediating effect of health status.

RESULTS

First, Public medical insurance system could significantly improve individual health status. Second, public medical insurance system will lengthen the labor supply time and elevate the labor supply rate by improving individual health status. Third, the influences of public medical insurance system on labor health status and supply vary with gender and age.

CONCLUSION

Public medical insurance system will generate positive influences on labor health status and labor supply. Hence, perfecting the public medical insurance system is able to mitigate the negative impacts of population aging and pandemic on the labor supply.

Public health insurance and the labor market: Evidence from China's Urban Resident Basic Medical Insurance

This study provides empirical evidence on the labor market effects of public health insurance using evidence from China. In 2007, China launched a national public health insurance program, Urban Resident Basic Medical Insurance (URBMI), targeting residents in urban areas who were not insured by employment-based health insurance. Using panel data from the China Health and Nutrition Survey, I identify the impacts of the program based on its staggered implementation across cities. I find that URBMI did not have a significant average causal effect on labor force participation. However, it did increase employment mobility, as evidenced by the decrease in long-term employment and expansion of fixed-term contract jobs and self-employment. After the program was implemented, job lock declined and job flexibility increased, especially among women, the less educated, and individuals with good health status. The results also suggest increased employment for unhealthy workers, indicating a direct health improvement effect.

Quality information disclosure and health insurance demand: evidence from VA hospital report cards

This study examines the effect of public reporting of quality information on the demand for public insurance. In particular, we examine the effect of the introduction of Veterans Affairs (VA) hospital quality report cards in 2008. Using data from the Current Population Survey in 2005-2015, we find that new information about the quality of a VA hospital had a significant effect on VA coverage among veterans living in the same Metropolitan Statistical Area (MSA). Despite the significant effect on VA coverage, the quality report did not have a spillover effect on veterans' labor supply. Moreover, updated quality information released in later years, which was presented in a less straightforward form, led to no additional changes in VA coverage. These findings suggest that quality reports for public insurance programs can be used as a policy lever to facilitate take up decision among potential beneficiaries.

Health insurance reform and retirement: Evidence from the Affordable Care Act

The Affordable Care Act (ACA) has provided millions of Americans with medical insurance but may have led to an increase in retirement among older individuals who are utilizing the newly available coverage options as a substitute for employer-provided insurance. Using data from the American Community Survey from 2009-2016, this hypothesis is tested by estimating the effect of the premium subsidies and Medicaid expansions of the ACA on retirement transitions for the non-Medicare eligible cohort of older Americans aged 55-64. Research results indicate a 2% and 8% decrease in labor force participation resulting from the premium subsidies and Medicaid expansions, respectively. Slightly larger estimates are found among a subgroup of adult couples. The study also finds suggestive evidence of crowd-out of employer-sponsored insurance by subsidized marketplace plans but finds no such effects from the Medicaid expansions.

[Job] Locked and [Un]loaded: The effect of the Affordable Care Act dependency mandate on reenlistment in the U.S. Army

One concern with employer-based health insurance is job lock or the inability for employees to leave their current employment for better opportunities for fear of losing benefits. We use the implementation of the Affordable Care Act's dependency mandate as a natural experiment. Data from the United States Army overcome some limitations in previous studies including the ability to examine workers with fixed contract expiration dates, uniform pay, and health coverage. We find that the ACA decreased reenlistment rates by 3.13 percent for enlisted soldiers aged 23-25. We also find that younger veterans who leave the Army are more likely to attend college. These findings show that the ACA reduced job lock and increased college-going.

The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans

This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs.

The Effect of Catastrophic Health Expenditure on Work After Retirement

Several factors can force retirees to go to paid work. Catastrophic health-care expenditure (CHCE) is one of the driving forces for retirees to go to paid work. This cross-sectional study was based on 6,307 Iran retirees’ data. Xu method was used to calculate CHCE, and a logit model was estimated to show the association between CHCE and bridge employment. Other control variables were added to the model. The findings showed that there was positive relationship between CHCE and bridge employment. Retirement pension had negative relationship with work after retirement. Prevalence of work after retirement was higher in people who lived in rural region and increased due to increase in household size. The financial constraint was the main pushing factor for the retiree to go to paid work. Thus, covering retirees with health insurances and identifying and listing diseases that may face the retirees with CHCE are some possible efforts to decrease CHCE.

Job Lock, Work, and Psychological Well-being in the United States

The purpose of the present study was to examine job lock in relation to well-being among workers in the U.S. Job lock refers to a circumstance in which a worker would like to retire or stop working altogether, but perceives that they cannot due to needing the income, and/or health insurance. Prior to examining job lock as a potential predictor of life satisfaction we first investigated the construct validity of job lock. Results from a sample of N=308 workers obtained via MTurk indicated that job lock due to financial need was more strongly associated with continuance and affective organizational commitment and job satisfaction compared to health insurance job lock. Job lock due to health insurance needs was related to a dimension of career entrenchment. We then tested hypotheses regarding the relation between job lock at T1 and life satisfaction at T2, two years later. Specifically, we hypothesized that perceptions of job lock would be negatively related to life satisfaction. Using two independent samples from the Health and Retirement Study (HRS), we found that both types of job lock were highly prevalent among workers age 62-65. Job lock due to money was significantly associated with lower life satisfaction 2 years later. The findings for job lock due to health insurance were mixed across the two samples. This study was an important first step toward examining the relation between job lock, an economic concept, in relation to workers' job attitudes and well-being.

Spousal labor market effects from government health insurance: Evidence from a veterans affairs expansion

Measuring the total impact of health insurance receipt on household labor supply is important in an era of increased access to publicly provided and subsidized insurance. Although government expansion of health insurance to older workers leads to direct labor supply reductions for recipients, there may be spillover effects on the labor supply of uncovered spouses. While the most basic model predicts a decrease in overall household work hours, financial incentives such as credit constraints, target income levels, and the need for own health insurance suggest that spousal labor supply might increase. In contrast, complementarities of spousal leisure would predict a decrease in labor supply for both spouses. Utilizing a mid-1990s expansion of health insurance for U.S. veterans, we provide evidence on the effects of public insurance availability on the labor supply of spouses. Using data from the Current Population Survey and Health and Retirement Study, we employ a difference-in-differences strategy to compare the labor market behavior of the wives of older male veterans and non-veterans before and after the VA health benefits expansion. Although husbands' labor supply decreases, wives' labor supply increases, suggesting that financial incentives dominate complementarities of spousal leisure. This effect is strongest for wives with lower education levels and lower levels of household wealth and those who were not previously employed full-time. These findings have implications for government programs such as Medicare and Social Security and the Affordable Care Act.

Public health insurance and disparate eligibility of spouses: The Medicare eligibility gap

I exploit the age-based eligibility structure of Medicare and the age gap between spouses to examine the impact of Medicare eligibility of an older spouse on the insurance coverage of younger, Medicare-ineligible spouses. Using a regression discontinuity framework, I find that Medicare eligibility of an older spouse can crowd-out the health insurance coverage of a younger spouse. Medicare eligibility of older wives increases the likelihood that younger husbands are uninsured. Younger wives are less likely to be covered through an employer-based plan and more likely to have non-group coverage after an older husband turns 65.

Retiree health insurance for public school employees: does it affect retirement?

Despite the widespread provision of retiree health insurance for public sector workers, little attention has been paid to its effects on employee retirement. This is in contrast to the large literature on health-insurance-induced "job-lock" in the private sector. I use the introduction of retiree health insurance for public school employees in combination with administrative data on their retirement to identify the effects of retiree health insurance. As expected, the availability of retiree health insurance for older workers allows employees to retire earlier. These behavioral changes have budgetary implications, likely making the programs self-financing rather than costly to taxpayers.

The spillover effect of National Health Insurance on household consumption patterns: evidence from a natural experiment in Taiwan

While providing financial risk protection was one of the major aims of introducing a National Health Insurance (NHI) program in Taiwan in 1995, one may also wonder how the households may exploit resources freed up and available to them as a result of reduced exposure to risk due to health insurance. This paper aims at studying and evaluating the impact of social insurance on these differing household consumption patterns. A differences-in-differences estimation model was applied to a sample of 17,899 households from the 1993-2000 Taiwan Survey of Family Income and Expenditure to assess the NHI's impact. This effect was evaluated by the changes in the proportion of the consumption expenditure devoted to medical items and non-medical items in the post-NHI period (1996-2000) compared to the pre-NHI period (1993-1994). Our study found that spending related to the improvement of housing conditions (rental and water bills) had the most significant increase, 1.87% (in the share). Furthermore, examining the NHI impact across socioeconomic status (SES) strata (in terms of income and education levels), our study found that households with the lowest SES experienced the largest increase in spending share (2.16%) for rental and water bills, and the least drop (0.64%) on education items. Recognizing how households can exploit the potential benefits associated with NHI provision could enable the government to devise specific policy tools to facilitate better targeting of investment decisions with limited resources available for less well-off households.

Comparison the Effects of Health Indicators on Male and Female Labor Supply, Evidence from Panel Data of Eastern Mediterranean Countries 1995-2010

BACKGROUND

Skilled labor force is very important in economic growth. Workers become skilled when they are healthy and able to be educated and work. In this study, we estimated the effects of health indicators on labor supply. We used labor force participation rate as the indicator of labor supply. We categorized this indicator into 2 indicators of female and male labor force participation rates and compared the results of each estimate with the other.

METHODS

This study was done in eastern Mediterranean countries between 1995 and 2011. We used a panel cointegration approach for estimating the models. We used Pesaran cross sectional dependency, Pesaran unit root test, and Westerlund panel cointegration for this issue. At the end, after confirmation of having random effect models, we estimated them with random effects.

RESULTS

Increasing the fertility rate decreased the female labor supply, but increased the male labor supply. However, public health expenditures increased the female labor supply, but decreased the male labor supply because of substitution effects. Similar results were found regarding urbanization. Gross domestic product had a positive relationship with female labor supply, but not with male labor supply. Besides, out of pocket health expenditures had a negative relationship with male labor supply, but no significant relationships with female labor supply.

CONCLUSION

The effects of the health variables were more severe in the female labor supply model compared to the male model. Countries must pay attention to women's health more and more to change the labor supply.

Does Retiree Health Insurance Encourage Early Retirement?

The strong link between health insurance and employment in the United States may cause workers to delay retirement until they become eligible for Medicare at age 65. However, some employers extend health insurance benefits to their retirees, and individuals who are eligible for such retiree health benefits need not wait until age 65 to retire with group health coverage. We investigate the impact of retiree health insurance on early retirement using employee-level data from 54 diverse firms that are clients of Towers Watson, a leading benefits consulting firm. We find that retiree health coverage has its strongest effects at ages 62 through 64. Coverage that includes an employer contribution is associated with a 6.3 percentage point (36.2 percent) increase in the probability of turnover at age 62, a 7.7 percentage point (48.8 percent) increase in the probability of turnover at age 63, and a 5.5 percentage point (38.0 percent) increase in the probability of turnover at age 64. Conditional on working at age 57, such coverage reduces the expected retirement age by almost three months and reduces the total number of person-years worked between ages 58 and 64 by 5.6 percent.

Public health insurance eligibility and labor force participation of low-income childless adults

The Affordable Care Act aims to substantially increase public health insurance eligibility among low-income childless adults. The literature suggests that public health insurance may have important implications for labor market participation. With data from the March supplement to the Current Population Survey, difference-in-difference multivariable regression modeling is used to examine the association between state-level public health insurance expansions and the likelihood of full-time employment, part-time employment, and not working among eligible childless adults. Results indicate that public health insurance eligibility is associated with a 2.2 percentage point decrease in full-time employment, a 0.8 percentage point increase in the likelihood of part-time employment, and a 1.4 percentage point increase in the likelihood of not working. These associations were greatest among those with worse health and those aged from 50 to 64 years. This analysis provides important insights into the potential labor market repercussions of health insurance expansions under the Affordable Care Act.

Evolution in intergenerational exchanges between elderly people and their grandchildren in Taiwan; data from a multiple round cross-sectional study from 1993 to 2007

Background

This study aimed to evaluate social evolution in Taiwan in recent decades using the changing pattern of care provided by grandparents for their grandchildren as an indicator.

Methods

Data from the second, fourth and sixth wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were used for the analysis. This survey collected individual characteristics, including age, gender, education, ethnicity, dwelling place, living with partners, co-resident with children, employment status, self-reported health status and their provision of care for their grandchildren. Information about the attitudes toward National Health Insurance (NHI) was further collected in a questionnaire of 1999 following the implementation of NHI in 1995. By elders, we mean persons 60 or more years old. By grandchildren, we mean persons under 16 years of age. First, changes in individual characteristics were compared during these study periods (chi-square test). Then the logistic regression was performed to determine how significantly elders' grandchild-care behavior was associated with their individual characteristics.

Results

The percentage of elders providing grandchild care increased from 7.7% in 1993 to 13.6% in 1999, and then to 19.4% in 2007. By analysis, significant association was found between behavior in taking care of grandchildren and individuals of lower age, grandmothers, those living with partners or co-residing with children, those unemployed and those with better self-reported health status. And the effect of year was confirmed in the multivariable analysis.

Conclusions

This study pointed out the changing pattern of elders' behavior in taking care of their grandchildren as the main indicator and their related individual characteristics. We argue the need for improving social security policies in an ageing society. We suggest that the interaction between population policies and those of social welfare, including policies for health care and childcare, should be carefully evaluated.