@article {10978, title = {ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study}, journal = {Inquiry : a journal of medical care organization, provision and financing}, volume = {57}, year = {2020}, abstract = {The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100\% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12\% reduction in metabolic syndrome; a 32\% reduction in complications from metabolic syndrome; an 18\% reduction in the likelihood of gross motor skills difficulties; and a 34\% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults.}, keywords = {crowd-out, difference-in-differences, Health Status, Insurance Coverage, Medicaid, near-elderly adults, Patient Protection and Affordable Care Act}, isbn = {1945-72430046-9580}, doi = {10.1177/0046958020935229}, author = {Melissa McInerney and Ruth Winecoff and Padmaja Ayyagari and Kosali I. Simon and M Kate Bundorf} } @article {11153, title = {Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study.}, journal = {PLoS One}, volume = {15}, year = {2020}, pages = {e0238356}, abstract = {

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample.

METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men{\textquoteright}s mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health.

RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency.

IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.

}, keywords = {Adult, African Americans, Aged, Aged, 80 and over, Chronic disease, Communication, Cross-Sectional Studies, Follow-Up Studies, Healthcare Disparities, Hispanic Americans, Humans, Insurance Coverage, Male, Middle Aged, Patient Education as Topic, Patient-Centered Care, Physician-Patient Relations, Prognosis, Racism}, issn = {1932-6203}, doi = {10.1371/journal.pone.0238356}, author = {Mitchell, Jamie A and Perry, Ramona} } @article {10466, title = {The Impact of Medicare Part D on Emergency Department Visits.}, journal = {Health Economics}, volume = {26}, year = {2017}, month = {2017 04}, pages = {536-544}, abstract = {

The Medicare Part D program introduced prescription drug coverage for seniors in 2006. We examine the impact of this program on the use of emergency department (ED) care. Using a difference-in-differences model, we find declines in the number of ED visits for non-emergency care but not for emergency care, suggesting that Part D may have led to better management of health and reduced unnecessary use of EDs. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Aged, Delivery of Health Care, Emergency Service, Hospital, Female, Humans, Insurance Coverage, Insurance, Health, Male, Medicare Part D, Middle Aged, prescription drugs, Surveys and Questionnaires, United States}, issn = {1099-1050}, doi = {10.1002/hec.3326}, author = {Padmaja Ayyagari and Dan M. Shane and George L Wehby} } @article {8377, title = {Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA.}, journal = {Int Dent J}, volume = {66}, year = {2016}, month = {2016 Feb}, pages = {36-48}, publisher = {66}, abstract = {

BACKGROUND: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries.

METHOD: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents>=51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use.

RESULTS: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance.

CONCLUSIONS: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.

}, keywords = {Aged, Aged, 80 and over, Demography, Dental Care, Europe, Female, Humans, Insurance Coverage, Interviews as Topic, Male, Middle Aged, Oral Health, Patient Acceptance of Health Care, United States}, issn = {0020-6539}, doi = {10.1111/idj.12190}, url = {http://onlinelibrary.wiley.com/doi/10.1111/idj.12190/epdf}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Widstrom, Eeva and Listl, Stefan} } @article {8674, title = {Physical and/or Cognitive Impairment, Out-of-Pocket Spending, and Medicaid Entry among Older Adults.}, journal = {J Urban Health}, volume = {93}, year = {2016}, month = {2016 10}, pages = {840-850}, abstract = {

While Medicare provides health insurance coverage for those over 65~years of age, many still are underinsured, experiencing substantial out-of-pocket costs for covered and non-covered services as a proportion of their income. Using the Health and Retirement Study (HRS), this study found that being underinsured is a significant predictor of entering into Medicaid coverage over a 16-year period. The rate of entering Medicaid was almost twice as high for those who were underinsured and with physical and/or cognitive impairment than those who were not, while supplemental health insurance reduced the rate of entering Medicaid by 30~\%. Providing more comprehensive coverage through the traditional Medicare program, including a ceiling on out-of-pocket expenditures or targeted support for those with physical or cognitive impairment, could postpone becoming covered by Medicaid and yield savings in Medicaid.

}, keywords = {Aged, Cognitive Dysfunction, Delivery of Health Care, Disabled Persons, Eligibility Determination, Female, Financing, Personal, Humans, Insurance Coverage, Insurance, Health, Male, Medicaid, Middle Aged, United States}, issn = {1468-2869}, doi = {10.1007/s11524-016-0078-1}, url = {https://link.springer.com/article/10.1007\%2Fs11524-016-0078-1}, author = {Willink, Amber and Davis, Karen and Schoen, Cathy and Jennifer L. Wolff} } @article {8815, title = {Prescription drug coverage and chronic pain.}, journal = {Int J Health Econ Manag}, volume = {16}, year = {2016}, month = {2016 Jun}, pages = {189-200}, abstract = {

Chronic pain is one of the most common chronic conditions affecting more than 50~\% of older adults. While pain management can be quite complex, prescription drugs are the most commonly used treatment modality. In this study, I examine whether increased access to prescription drugs due to the introduction of the Medicare Part D program in 2006 led to better management of pain among the elderly. While prior work has identified increases in the utilization of analgesics due to the introduction of Medicare Part D, the extent to which this increase in drug use actually improved the well-being of older adults is not known. Using data from the Health and Retirement Study, I employ a difference-in-differences strategy that compares pre versus post 2006 changes in pain related outcomes between Medicare eligible persons and a younger ineligible group. I find that Medicare Part D significantly reduced pain related activity limitations among a sample of older adults who report being troubled by pain.

}, keywords = {Analgesics, Chronic pain, Humans, Insurance Coverage, Medicare Part D, prescription drugs, Retirement, United States}, issn = {2199-9031}, doi = {10.1007/s10754-016-9185-5}, url = {http://link.springer.com/10.1007/s10754-016-9185-5}, author = {Padmaja Ayyagari} } @article {8160, title = {The effect of dental insurance on the use of dental care for older adults: a partial identification analysis.}, journal = {Health Econ}, volume = {24}, year = {2015}, note = {Export Date: 6 August 2014 Article in Press}, month = {2015 Jul}, pages = {840-58}, publisher = {24}, abstract = {

We evaluate the impact of dental insurance on the use of dental services using a potential outcomes identification framework designed to handle uncertainty created by unknown counterfactuals-that is, the endogenous selection problem-and uncertainty about the reliability of self-reported insurance status. Using data from the health and retirement study, we estimate that utilization rates of adults older than 50 years would increase from 75\% to around 80\% under universal dental coverage.

}, keywords = {Aged, Dental Care, Female, Humans, Insurance Coverage, Insurance, Dental, Male, Middle Aged, Models, Econometric, Reproducibility of Results}, issn = {1099-1050}, doi = {10.1002/hec.3064}, author = {Kreider, Brent and Richard J. Manski and John F Moeller and John V Pepper} } @article {10490, title = {Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending.}, journal = {Health Affairs (Project Hope)}, volume = {34}, year = {2015}, month = {2015 Dec}, pages = {2181-91}, abstract = {

About half of older Americans will need a high level of assistance with routine activities for a prolonged period of time. This help is commonly referred to as long-term services and supports (LTSS). Under current policies, these individuals will fund roughly half of their paid care out of pocket. Partly as a result of high costs and uncertainty, relatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. To show how policy changes could expand insurance{\textquoteright}s role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.

}, keywords = {Aged, Financing, Government, Humans, Insurance, Insurance Coverage, Long-term Care, Medicaid, Middle Aged, Policy Making, United States}, issn = {1544-5208}, doi = {10.1377/hlthaff.2015.1226}, author = {Melissa Favreault and Gleckman, Howard and Richard W. Johnson} } @article {8006, title = {Cumulative inequality and racial disparities in health: private insurance coverage and black/white differences in functional limitations.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {69}, year = {2014}, month = {2014 Sep}, pages = {798-808}, publisher = {69}, abstract = {

OBJECTIVES: To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans.

METHOD: Data come from 7 waves of the Health and Retirement Study (1996-2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations.

RESULTS: In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations.

DISCUSSION: Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Cross-Sectional Studies, Female, Health Status Disparities, Hispanic or Latino, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medicare, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu005}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/24/geronb.gbu005.abstract}, author = {Ben Lennox Kail and Miles G Taylor} } @article {8128, title = {Purpose in life and use of preventive health care services.}, journal = {Proc Natl Acad Sci U S A}, volume = {111}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Nov 18}, pages = {16331-6}, publisher = {111}, abstract = {

Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95\% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95\% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95\% CI = 1.16-1.39) or pap smear (OR = 1.16, 95\% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95\% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17\% fewer nights spent in the hospital (rate ratio = 0.83, 95\% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.

}, keywords = {Aged, Aged, 80 and over, Early Detection of Cancer, Educational Status, ethnicity, Female, Habits, Hematologic Tests, Hospitalization, Humans, Influenza Vaccines, Insurance Coverage, Male, Marital Status, Middle Aged, Models, Psychological, Motivation, Patient Acceptance of Health Care, Preventive Health Services, Surveys and Questionnaires, Vaccination}, issn = {1091-6490}, doi = {10.1073/pnas.1414826111}, author = {Eric S Kim and Victor J Strecher and Carol D Ryff} } @article {7825, title = {Patterns of older Americans{\textquoteright} health care utilization over time.}, journal = {Am J Public Health}, volume = {103}, year = {2013}, month = {2013 Jul}, pages = {1314-24}, publisher = {103}, abstract = {

OBJECTIVES: We analyzed correlates of older Americans{\textquoteright} continuous and transitional health care utilization over 4 years.

METHODS: We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004-2008 survey periods.

RESULTS: Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction.

CONCLUSIONS: Older individuals{\textquoteright} health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Delivery of Health Care, Female, Health Services, Health Status, Health Surveys, Home Care Services, Hospitalization, Humans, Income, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Middle Aged, Office Visits, Patient Acceptance of Health Care, Time Factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301124}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {7689, title = {Coverage or costs: the role of health insurance in labor market reentry among early retirees.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Jan}, pages = {113-20}, publisher = {67B}, abstract = {

OBJECTIVES: This study evaluated the impact of insurance coverage on the odds of returning to work after early retirement and the change in insurance coverage after returning to work.

METHOD: The Health and Retirement Study was used to estimate hierarchical linear models of transitions to full-time work and part-time work relative to remaining retired. A chi-square test was also used to assess change in insurance coverage after returning to work.

RESULTS: Insurance coverage was unrelated to the odds of transitioning to full-time work. However, relative to employer-provided insurance, private nongroup insurance increased the odds of transitioning to part-time work, whereas public insurance reduced the odds of making this transition. Additionally, after returning to work, insurance coverage increased among those who were without employer-provided insurance in retirement.

DISCUSSION: Results indicated that source of coverage may be more useful in explaining returns to part-time work than simply whether people have coverage at all. In other words, the mechanism underlying the positive relationship between insurance and returning to work appeared to be limited to those who return to work because of the cost of private nongroup insurance. Among these people, however, there was some evidence that they are able to secure new coverage once they return to work.

}, keywords = {Employment, Female, Health Benefit Plans, Employee, Health Surveys, Humans, Insurance Coverage, Insurance, Health, Male, Middle Aged, Retirement, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr130}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2579962341andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Ben Lennox Kail} } @article {7758, title = {Health service use among the previously uninsured: is subsidized health insurance enough?}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Oct}, pages = {1155-68}, publisher = {21}, abstract = {

Although it has been shown that gaining Medicare coverage at age 65 years increases health service use among the uninsured, difficulty in changing habits or differences in the characteristics of previously uninsured compared with insured individuals may mean that the previously uninsured continue to use the healthcare system differently from others. This study uses Medicare claims data linked to two different surveys--the National Health Interview Survey and the Health and Retirement Study--to describe the relationship between insurance status before age 65 years and the use of Medicare-covered services beginning at age 65 years. Although we do not find statistically significant differences in Medicare expenditures or in the number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 years continue to use the healthcare system differently from those who were privately insured. Specifically, they have 16\% fewer visits to office-based physicians but make 18\% and 43\% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured seem to continue to use the healthcare system differently from the previously insured. This question may be important to consider as health coverage expansions are implemented.

}, keywords = {Aged, Female, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Male, Medically Uninsured, Medicare, Middle Aged, Socioeconomic factors, United States}, issn = {1099-1050}, doi = {10.1002/hec.1780}, author = {Decker, Sandra L and Jalpa A Doshi and Amy E. Knaup and Daniel Polsky} } @article {7638, title = {Anticipatory ex ante moral hazard and the effect of Medicare on prevention.}, journal = {Health Econ}, volume = {20}, year = {2011}, note = {de Preux, Laure B Comparative Study England Health economics Health Econ. 2011 Sep;20(9):1056-72. doi: 10.1002/hec.1778.}, month = {2011 Sep}, pages = {1056-72}, publisher = {20}, abstract = {

This paper extends the ex ante moral hazard model to allow healthy lifestyles to reduce the probability of illness in future periods, so that current preventive behaviour may be affected by anticipated changes in future insurance coverage. In the United States, Medicare is offered to almost all the population at the age of 65. We use nine waves of the US Health and Retirement Study to compare lifestyles before and after 65 of those insured and not insured pre 65. The double-robust approach, which combines propensity score and regression, is used to compare trends in lifestyle (physical activity, smoking, drinking) of the two groups before and after receiving Medicare, using both difference-in-differences and difference-in-differences-in-differences. There is no clear effect of the receipt of Medicare or its anticipation on alcohol consumption nor smoking behaviour, but the previously uninsured do reduce physical activity just before receiving Medicare.

}, keywords = {Age Factors, Aged, Alcohol Drinking, Female, Health Behavior, Health Services, Humans, Insurance Coverage, Male, Medically Uninsured, Medicare, Middle Aged, Morals, Motor Activity, Proportional Hazards Models, Regression Analysis, Smoking, United States}, issn = {1099-1050}, doi = {10.1002/hec.1778}, author = {de Preux, Laure B} } @article {7547, title = {Socioeconomic inequalities in self-rated health among middle-aged and older adults.}, journal = {Soc Work Health Care}, volume = {50}, year = {2011}, month = {2011}, pages = {124-42}, publisher = {50}, abstract = {

Despite increased attention to health disparities in the United States, few studies have examined the impact of socioeconomic inequalities on self-rated health over time. Using data from the Health and Retirement Study, this article investigates socioeconomic inequalities in self-rated health among middle-aged and older adults. The findings indicated that higher level of income, assets, and education, and having private health insurance predicted better self-rated health. In particular, increases in income or assets predicted slower decline in self-rated health. Interestingly, economic status had greater impact on females{\textquoteright} decline in self-rated health. Blacks were less likely to suffer rapid decline in self-rated health than were whites. The findings led to the conclusion that health disparities should be understood as the interplay of socioeconomic status, gender, and race/ethnicity.

}, keywords = {Aged, Female, Health Status Disparities, Humans, Insurance Coverage, Insurance, Health, Male, Middle Aged, Self Report, Sex Factors, Socioeconomic factors}, issn = {1541-034X}, doi = {10.1080/00981389.2010.527787}, author = {Kim, Jinhyun} } @article {7674, title = {Who pays for obesity?}, journal = {J Econ Perspect}, volume = {25}, year = {2011}, month = {2011 Winter}, pages = {139-58}, publisher = {25}, abstract = {

Adult obesity is a growing problem. From 1962 to 2006, obesity prevalence nearly tripled to 35.1 percent of adults. The rising prevalence of obesity is not limited to a particular socioeconomic group and is not unique to the United States. Should this widespread obesity epidemic be a cause for alarm? From a personal health perspective, the answer is an emphatic "yes." But when it comes to justifications of public policy for reducing obesity, the analysis becomes more complex. A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population{\textemdash}a statement which is then taken to justify public policy interventions. But the question of who pays for obesity is an empirical one, and it involves analysis of how obese people fare in labor markets and health insurance markets. We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity. In the conclusion, we offer a few thoughts about some complexities of such a justification.

}, keywords = {Adult, Cost of Illness, Financing, Personal, Health Benefit Plans, Employee, Health Care Costs, health policy, Humans, Income, Insurance Coverage, Insurance Pools, Insurance, Health, Life Expectancy, Models, Econometric, Obesity, Prevalence, Private Sector, Public Sector, Risk Adjustment, Social Control Policies, United States}, issn = {0895-3309}, doi = {10.1257/jep.25.1.139}, author = {Bhattacharya, Jay and Sood, Neeraj} } @article {7535, title = {Dental care expenditures and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, month = {2010 Spring}, pages = {148-55}, publisher = {70}, abstract = {

OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS).

METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status.

CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.

}, keywords = {Age Factors, Aged, Dental Care, Educational Status, ethnicity, Female, Financing, Personal, Humans, Income, Insurance Coverage, Insurance, Dental, Male, Marital Status, Middle Aged, Mouth, Edentulous, Retirement, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00156.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {7376, title = {Dental care coverage transitions.}, journal = {Am J Manag Care}, volume = {15}, year = {2009}, month = {2009 Oct}, pages = {729-35}, publisher = {15}, abstract = {

OBJECTIVE: To examine dental insurance transition dynamics in the context of changing employment and retirement status.

STUDY DESIGN: Data from the Health and Retirement Study (HRS) were analyzed for individuals 51 years and older between the 2004 and 2006 waves of the HRS.

METHODS: The primary focus of the analysis is the relationship between retirement and transitions in dental care coverage. We calculate and present bivariate relationships between dental coverage and retirement status transitions over time and estimate a multivariable model of dental coverage controlling for retirement and other potentially confounding covariates.

RESULTS: Older adults are likely to lose their dental coverage on entering retirement compared with those who remain in the labor force between waves of the HRS. While more than half of those persons in the youngest group (51-64 years) were covered over this entire period, two-thirds of those in the oldest group (>or=75 years) were without coverage over the same period. We observe a high percentage of older persons flowing into and out of dental coverage over the period of our study, similar to flows into and out of poverty.

CONCLUSIONS: Dental insurance is an important factor in the decision to seek dental care. Yet, no dental coverage is provided by Medicare, which provides medical insurance for almost all Americans 65 years and older. This loss of coverage could lead to distortions in the timing of when to seek care, ultimately leading to worse oral and overall health.

}, keywords = {Aged, Career Mobility, Female, Health Benefit Plans, Employee, Humans, Insurance Coverage, Insurance, Dental, Interviews as Topic, Male, Middle Aged, United States}, issn = {1936-2692}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {7380, title = {Financial status, employment, and insurance among older cancer survivors.}, journal = {J Gen Intern Med}, volume = {24 Suppl 2}, year = {2009}, month = {2009 Nov}, pages = {S438-45}, publisher = {24}, abstract = {

BACKGROUND: Few data are available about the socioeconomic impact of cancer for long-term cancer survivors.

OBJECTIVES: To investigate socioeconomic outcomes among older cancer survivors compared to non-cancer patients.

DATA SOURCE: 2002 Health and Retirement Study.

STUDY DESIGN: We studied 964 cancer survivors of > 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans ages >or= 55 years responding to the 2002 Health and Retirement Study.

MEASURES: We compared household income, housing assets, net worth, insurance, employment, and future work expectations.

ANALYSES: Propensity score methods were used to control for baseline differences between cancer survivors and controls.

RESULTS: Female cancer survivors did not differ from non-cancer patients in terms of income, housing assets, net worth, or likelihood of current employment (all P > 0.20); but more were self-employed (25.0\% vs. 17.7\%; P = 0.03), and fewer were confident that if they lost their job they would find an equally good job in the next few months (38.4\% vs. 45.9\%; P = 0.03). Among men, cancer survivors and noncancer patients had similar income and housing assets (both P >or= 0.10) but differed somewhat in net worth (P = 0.04). Male cancer survivors were less likely than other men to be currently employed (25.2\% vs. 29.7\%) and more likely to be retired (66.9\% vs. 62.2\%), although the P value did not reach statistical significance (P = 0.06). Men were also less optimistic about finding an equally good job in the next few months if they lost their current job (33.5\% vs. 46.9\%), although this result was not significant (P = 0.11).

CONCLUSIONS: Despite generally similar socioeconomic outcomes for cancer survivors and noncancer patients ages >or=55 years, a better understanding of employment experience and pessimism regarding work prospects may help to shape policies to benefit cancer survivors.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Data collection, Employment, Female, Financing, Personal, Humans, Income, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Middle Aged, Neoplasms, Socioeconomic factors, Survivors}, issn = {1525-1497}, doi = {10.1007/s11606-009-1034-5}, author = {Norredam, Marie and Meara, Ellen and Landrum, Mary Beth and Haiden A. Huskamp and Nancy L. Keating} } @article {7304, title = {The health effects of Medicare for the near-elderly uninsured.}, journal = {Health Serv Res}, volume = {44}, year = {2009}, month = {2009 Jun}, pages = {926-45}, publisher = {44}, abstract = {

OBJECTIVE: To determine whether Medicare enrollment at age 65 has an effect on the health trajectory of the near-elderly uninsured.

DATA SOURCES: Eight biennial waves (1992-2006) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61 year olds and their spouses.

STUDY DESIGN: We use a quasi-experimental approach to compare the health effects of insurance for the near-elderly uninsured with previously insured contemporaneous controls. The primary outcome measure is overall self-reported health status combined with mortality (i.e., excellent to very good, good, fair to poor, dead).

RESULTS: The change in the trajectory of overall health status for the previously uninsured that can be attributed to Medicare is small and not statistically significant. For every 100 persons in the previously uninsured group, joining Medicare is associated with 0.6 fewer in excellent or very good health (95 percent CI: -4.8, 3.3), 0.3 more in good health (95 percent CI: -3.8, 4.1), 2.5 fewer in fair or poor health (95 percent CI: -7.4, 2.3), and 2.8 more dead (-4.0, 10.0) by age 73. The health trajectory patterns from physician objective health measures are similarly small and not statistically significant.

CONCLUSIONS: Medicare coverage at age 65 for the previously uninsured is not linked to improvements in overall health status.

}, keywords = {Aged, Attitude to Health, Female, Follow-Up Studies, Health Services Accessibility, Health Services Research, Health Status, Health Surveys, Humans, Insurance Coverage, Logistic Models, Male, Medically Uninsured, Medicare, Mortality, Multivariate Analysis, Program Evaluation, Retirement, Socioeconomic factors, Statistics, Nonparametric, United States}, issn = {1475-6773}, doi = {10.1111/j.1475-6773.2009.00964.x}, author = {Daniel Polsky and Jalpa A Doshi and Jos{\'e} J Escarce and Manning, Willard and Susan M Paddock and Cen, Liyi and Jeannette Rogowski} } @article {7202, title = {Health insurance coverage as people approach and pass age-eligibility for Medicare.}, journal = {J Aging Soc Policy}, volume = {20}, year = {2008}, month = {2008}, pages = {29-44}, publisher = {20}, abstract = {

This study uses six waves of the Health and Retirement Study (HRS) to measure dynamics of health insurance coverage as people approach and pass age-eligibility for Medicare. Thirteen percent of 59- to 64-year-olds were uninsured and 13\% of 65- to 70-year-olds relied solely on Medicare. Those unmarried, in good health, and in poor health had an increased likelihood of being uninsured before age-eligibility for Medicare, while non-whites and those in good health had an increased likelihood of having Medicare-only coverage after age-eligibility for Medicare. Although only a small percentage was continually without coverage or with Medicare-only coverage, a substantial percentage had these coverage types at some point. Limitations and policy implications are included.

}, keywords = {Aged, Eligibility Determination, Female, Humans, Insurance Coverage, Insurance, Health, Male, Medicare, Middle Aged, United States}, issn = {0895-9420}, doi = {10.1300/j031v20n01_02}, author = {Caffrey, Christine and Christine L Himes} } @article {7262, title = {Job loss, retirement and the mental health of older Americans.}, journal = {J Ment Health Policy Econ}, volume = {11}, year = {2008}, month = {2008 Dec}, pages = {167-76}, publisher = {11}, abstract = {

BACKGROUND: Millions of older individuals cope with physical limitations, cognitive changes, and various losses such as bereavement that are commonly associated with aging. Given increased vulnerability to various health problems during aging, work displacement might exacerbate these due to additional distress and to possible changes in medical coverage. Older Americans are of increasing interest to researchers and policymakers due to the sheer size of the Baby Boom cohort, which is approaching retirement age, and due to the general decline in job security in the U.S. labor market.

AIMS OF THE STUDY: This research compares and contrasts the effect of involuntary job loss and retirement on the mental health of older Americans. Furthermore, it examines the impact of re-employment on the depressive symptoms.

METHODS: There are two fundamental empirical challenges in isolating the effect of employment status on mental health. The first is to control for unobserved heterogeneity--all latent factors that could impact mental health so as to establish the correct magnitude of the effect of employment status. The second challenge is to verify the direction of causality. First difference models are used to control for latent effects and a two-stage least squares regression is used to account for reverse causality.

RESULTS: We find that involuntary job loss worsens mental health, and re-employment recaptures the past mental health status. Retirement is found to improve mental health of older Americans.

DISCUSSION: With the use of longitudinal data from the Health and Retirement Study surveys and the adoption of proper measures to control for the possibility of reverse causality, this study provides strong evidence of elevating depressive symptoms with involuntary job displacement even after controlling for other late-life events. Women suffer from greater distress levels than men after job loss due to business closure or lay-off. However, women also exhibit better psychological well-being than men following retirement. The present study is the first to report that the re-employment of involuntary job-loss sufferers leads to a recapturing of past mental health status. Additionally, we find that re-entering the labor force is psychologically beneficial to retirees as well.

IMPLICATIONS FOR HEALTH CARE PROVISION: It is well established that out-of-pocket expenditures on all forms of health care for seniors with self-diagnosed depression significantly exceeds expenditures for seniors with other common ailments such as hypertension and arthritis in the U.S. Thus, our research suggests that re-employment of older Americans displaced from the labor force will be cost-effective with regard to personal mental health outcomes.

IMPLICATIONS FOR HEALTH POLICIES: That re-employment of involuntary job loss sufferers leads to a recapturing of past mental health status illuminates one potential policy trade off - increased resources dedicated to job training and placement for older U.S. workers could reap benefits with regard to reduced private and public mental health expenditures.

IMPLICATIONS FOR FURTHER RESEARCH: Further research could more clearly assess the degree to which the mental health benefits of employment among older Americans would warrant the expansion of job training and employment programs aimed at this group.

}, keywords = {depression, Female, Health Status, Humans, Insurance Coverage, Insurance, Health, Life Change Events, Longitudinal Studies, Male, Mental Health, Middle Aged, Retirement, Socioeconomic factors, Stress, Psychological, Unemployment, United States}, issn = {1091-4358}, doi = {10.2139/ssrn.991134}, author = {Mandal, Bidisha and Roe, Brian} } @article {7138, title = {Risk of nursing home admission among older americans: does states{\textquoteright} spending on home- and community-based services matter?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S169-78}, publisher = {62B}, abstract = {

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states{\textquoteright} generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects.

METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.

RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35\%.

DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cohort Studies, Cost Savings, Cost-Benefit Analysis, Female, Financing, Government, Health Expenditures, Home Care Services, Homes for the Aged, Humans, Insurance Coverage, Long-term Care, Male, Medicaid, Medicare, Nursing homes, Patient Admission, Patient Readmission, Risk Assessment, Risk Factors, State Health Plans, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s169}, author = {Muramatsu, Naoko and yin, Hongjun and Richard T. Campbell and Ruby L Hoyem and Martha A. Jacob and Christopher Ross} } @article {7089, title = {Insurance coverage and health care use among near-elderly women.}, journal = {Womens Health Issues}, volume = {16}, year = {2006}, note = {Official publication of the Jacobs Institute of Women{\textquoteright}s Health}, month = {2006 May-Jun}, pages = {139-48}, publisher = {16}, abstract = {

OBJECTIVES: Data on near-elderly (ages 55-64) women{\textquoteright}s access to and use of health care have been limited. In this study, we sought to examine the status of near-elderly women{\textquoteright}s health insurance coverage in the United States and how it may influence their use of health care services.

METHODS: A nationwide random sample of women aged 55-64 was drawn from the 2002 wave of the Health and Retirement Study. Descriptive statistics were calculated and multivariable regression analyses were performed to quantify the impact of insurance coverage on near-elderly women{\textquoteright}s use of outpatient services, inpatient services, and prescription medication over a 2-year period.

RESULTS: In 2002, 9.4\% of near-elderly women in the United States were uninsured and 15.4\% had public coverage. Those who had coverage for a particular service were significantly more likely to use that service compared to women without coverage, with odds ratios ranging from 2.0-6.7 for services such as a physician visit, hospital stay, dental visit, and use of prescription medication. Among those who had at least one physician visit, near-elderly women who had some of the cost covered by insurance reported significantly more visits than women without coverage. Likewise, for near-elderly women regularly taking prescription medications, having more extensive coverage significantly increased their likelihood of medication adherence. The frequency of hospitalization was also higher for women who had complete coverage for the cost.

CONCLUSIONS: The nature of a near-elderly woman{\textquoteright}s insurance coverage significantly affects her use of health care services. More attention is needed to improve the health care of near-elderly women with inadequate insurance coverage.

}, keywords = {Attitude to Health, Female, Health Services Accessibility, Health Services Needs and Demand, Health Status, Humans, Insurance Coverage, Insurance, Health, Medically Uninsured, Middle Aged, Patient Acceptance of Health Care, Socioeconomic factors, United States, Women{\textquoteright}s Health, Women{\textquoteright}s Health Services}, issn = {1049-3867}, doi = {10.1016/j.whi.2006.02.005}, author = {Xiao Xu and Patel, Divya A. and Vahratian, Anjel and Ransom, Scott B.} } @article {7017, title = {Health insurance coverage during the years preceding medicare eligibility.}, journal = {Arch Intern Med}, volume = {165}, year = {2005}, month = {2005 Apr 11}, pages = {770-6}, publisher = {165}, abstract = {

BACKGROUND: Adults in late middle age who lack health insurance are more likely to die or experience a decline in their overall health. Because most estimates of the uninsured are cross-sectional, the true number of individuals whose health is at risk from being uninsured is unclear.

METHODS: We analyzed a nationally representative sample of 6065 US adults 51 to 57 years old who were interviewed in 1992, 1994, 1996, 1998, and 2000 as part of the Health and Retirement Study. Insurance coverage was determined at the time of each interview and classified as private, public, or uninsured. Longitudinal data were used to determine the proportion of individuals who were uninsured at any interview during the 8-year study period.

RESULTS: The proportion of participants who were uninsured at the time of the 1992, 1994, 1996, 1998, and 2000 interviews was 14.3\%, 10.8\%, 9.7\%, 8.8\%, and 8.2\%, respectively. People frequently transitioned between having insurance and being uninsured. As a result, despite the declining prevalence of being uninsured, the percentage who were uninsured at least once during the 8-year period rose to 23.3\% by 2000; few participants (2.6\%) were continuously uninsured. Only 60.1\% of participants were continuously enrolled in private insurance across all 5 interviews.

CONCLUSIONS: The proportion of US adults in late middle age at risk from being uninsured over a 10-year follow-up period was 2 to 3 times higher than cross-sectional estimates. At least one quarter of older adults will be uninsured at some point during the years preceding eligibility for Medicare.

}, keywords = {Age Factors, Black or African American, Cohort Studies, Female, Health Status, Hispanic or Latino, Humans, Insurance Coverage, Insurance, Health, Male, Medically Uninsured, Middle Aged, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0003-9926}, doi = {10.1001/archinte.165.7.770}, author = {David W. Baker and Joseph J Sudano} } @article {7053, title = {Supplemental private health insurance and depressive symptoms in older married couples.}, journal = {Int J Aging Hum Dev}, volume = {61}, year = {2005}, month = {2005}, pages = {293-312}, publisher = {61}, abstract = {

Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.

}, keywords = {Aged, Aged, 80 and over, Analysis of Variance, Black People, Chi-Square Distribution, depression, Female, Humans, Insurance Coverage, Insurance, Health, Linear Models, Male, Risk Factors, Spouses, United States, White People}, issn = {0091-4150}, doi = {10.2190/21LA-XQCE-BKJF-MC17}, author = {Min, Meeyoung O. and Aloen L. Townsend and Baila Miller and Rovine, Michael J.} } @article {6925, title = {The effect of heavy drinking on social security old-age and survivors insurance contributions and benefits.}, journal = {Milbank Q}, volume = {82}, year = {2004}, note = {RDA 1996-024}, month = {2004}, pages = {507-46, table of contents}, publisher = {82}, abstract = {

This article estimates the effects of heavy alcohol consumption on Social Security Old-Age and Survivor Insurance (OASI) contributions and benefits. The analysis accounts for differential earnings and mortality experiences of individuals with different alcohol consumption patterns and controls for other characteristics, including smoking. Relative to moderate drinkers, heavy drinkers receive fewer OASI benefits relative to their contributions. Ironically, for each cohort of 25-year-olds, eliminating heavy drinking costs the program an additional $3 billion over the cohort{\textquoteright}s lifetime. Public health campaigns are designed to improve individual health-relevant behaviors and, in the long run, increase longevity. Therefore, if programs for the elderly are structured as longevity-independent defined benefit programs, their success will reward healthier behaviors but increase these programs{\textquoteright} outlays and worsen their financial condition.

}, keywords = {Accidents, Traffic, Adolescent, Adult, Aged, Aged, 80 and over, Alcoholism, Cost Sharing, Female, Health Behavior, Humans, Insurance Coverage, Life Expectancy, Male, Middle Aged, Old Age Assistance, Social Security, United States}, issn = {0887-378X}, doi = {10.1111/j.0887-378X.2004.00320.x}, author = {Ostermann, Jan and Frank A Sloan} } @article {6935, title = {Health insurance coverage and mortality among the near-elderly.}, journal = {Health Aff (Millwood)}, volume = {23}, year = {2004}, month = {2004 Jul-Aug}, pages = {223-33}, publisher = {23}, abstract = {

Uninsured near-elderly people may be particularly at risk for adverse health outcomes. We compared mortality of a nationally representative cohort of insured and uninsured near-elderly people with stratification by race; income; and the presence of diabetes, hypertension, or heart disease, using propensity-score methods to adjust for numerous characteristics. Lacking health insurance was associated with substantially higher adjusted mortality among adults who were white; had low incomes; or had diabetes, hypertension, or heart disease. Expanding coverage to the near-elderly uninsured may greatly improve health outcomes for these groups.

}, keywords = {Cohort Studies, Female, health policy, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Mortality, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.23.4.223}, author = {J. Michael McWilliams and Alan M. Zaslavsky and Meara, Ellen and John Z. Ayanian} } @article {6921, title = {Out-of-pocket health care expenditures among older Americans with dementia.}, journal = {Alzheimer Dis Assoc Disord}, volume = {18}, year = {2004}, month = {2004 Apr-Jun}, pages = {90-8}, publisher = {18}, abstract = {

The number of older individuals with dementia will likely increase significantly in the next decades, but there is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by cognitively impaired individuals and their families. We used data from the 1993 and 1995 Asset and Health Dynamics Study, a nationally representative longitudinal survey of older Americans, to determine the OOPE for individuals with and without dementia. Dementia was identified in 1993 using a modified version of the Telephone Interview for Cognitive Status for self-respondents, and proxy assessment of memory and judgment for proxy respondents. In 1995, respondents reported OOPE over the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. The adjusted mean annual OOPE was 1,350 US dollars for those without dementia, 2,150 US dollars for those with mild/moderate dementia, and 3,010 US dollars for those with severe dementia (p < 0.01). Expenditures for hospital/nursing home care (1,770 per year US dollars) and prescription medications (800 per year US dollars) were the largest OOPE components for those with severe dementia. We conclude that dementia is independently associated with significantly higher OOPE for medical care compared with those with normal cognitive function. Severe dementia is associated with a doubling of OOPE, mainly due to higher payments for long-term care. Given that the number of older Americans with dementia will likely increase significantly in the coming decades, changes in public funding aimed at reducing OOPE for both long-term care and prescription medications would have considerable impact on individuals with dementia and their families.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Costs and Cost Analysis, Data Interpretation, Statistical, Female, Financing, Personal, Health Care Costs, Health Expenditures, Health Surveys, Humans, Insurance Coverage, Longitudinal Studies, Male}, issn = {0893-0341}, doi = {10.1097/01.wad.0000126620.73791.3e}, author = {Kenneth M. Langa and Eric B Larson and Robert B Wallace and A. Mark Fendrick and Norman L Foster and Mohammed U Kabeto and David R Weir and Robert J. Willis and A. Regula Herzog} } @article {6849, title = {Intermittent lack of health insurance coverage and use of preventive services.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Jan}, pages = {130-7}, publisher = {93}, abstract = {

OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services.

METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study.

RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services.

CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.

}, keywords = {Episode of Care, Female, Health Behavior, Health Status, Humans, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Outcome Assessment, Health Care, Patient Acceptance of Health Care, Preventive Health Services, Socioeconomic factors, United States}, issn = {0090-0036}, doi = {10.2105/ajph.93.1.130}, author = {Joseph J Sudano and David W. Baker} } @article {6739, title = {Long-term care and nursing home coverage: are adult children substitutes for insurance policies?}, journal = {J Health Econ}, volume = {20}, year = {2001}, note = {RDA 1999-001}, month = {2001 Jul}, pages = {527-47}, publisher = {20}, abstract = {

Recent theoretical work suggests that in some cases, parents will forego the purchase of long-term care insurance and rely on child-provided care in old age. This paper uses data from the Asset and Health Dynamics survey and the Panel Study of Income Dynamics to examine whether the availability of children and other potential caregivers explains why so few elderly persons have long-term care insurance. In contrast to the notion that family members serve as substitutes for long-term care insurance, variables measuring the availability of informal caregivers have no statistically significant effect in models of insurance ownership and models of intentions to purchase insurance.

}, keywords = {Adult, Aged, Caregivers, Family, Female, Home Nursing, Humans, Insurance Coverage, Insurance, Long-Term Care, Intergenerational Relations, Long-term Care, Male, Models, Statistical, Nursing homes}, issn = {0167-6296}, doi = {10.1016/s0167-6296(01)00078-9}, author = {Jennifer M Mellor} } @article {6698, title = {Uninsured status and out-of-pocket costs at midlife.}, journal = {Health Serv Res}, volume = {35}, year = {2000}, month = {2000 Dec}, pages = {911-32}, publisher = {35}, abstract = {

OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period.

DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline.

STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage.

PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance.

CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.

}, keywords = {Age Factors, Female, Financing, Personal, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Models, Econometric, Multivariate Analysis, Surveys and Questionnaires, United States}, issn = {0017-9124}, author = {Richard W. Johnson and Crystal, Stephen} } @article {6608, title = {Life transitions and health insurance coverage of the near elderly.}, journal = {Med Care}, volume = {36}, year = {1998}, month = {1998 Feb}, pages = {110-25}, publisher = {36}, abstract = {

OBJECTIVES: This study addresses three issues. (1) What are demographic wealth, employment, and health characteristics of near-elderly persons losing or acquiring health insurance coverage? Specifically, (2) what are the effects of life transitions, including changes in employment status, health, and marital status? (3) To what extent do public policies protect such persons against coverage loss, including various state policies recently implemented to increase access to insurance?

METHODS: The authors used the 1992 and 1994 waves of the Health and Retirement Study to analyze coverage among adults aged 51 to 64 years.

RESULTS: One in five near-elderly persons experienced a change in insurance coverage from 1992 to 1994. Yet, there was no significant change in the mix of coverage as those losing one form of coverage were replaced by others acquiring similar coverage.

CONCLUSIONS: Individuals whose health deteriorated significantly were not more likely than others to suffer a subsequent loss of coverage, due to substitution of retiree or individual coverage for those losing private coverage and acquisition of Medicaid and Medicare coverage for one in five uninsured. State policies to increase access to private health insurance generally did not prevent individuals from losing coverage or allow the uninsured to gain coverage. Major determinants of the probability of being insured were education, employment status of person and spouse, and work disability status. Other measures of health and functional status did not affect the probability of being insured, but had important impacts on the probability of having public coverage, conditional on being insured.

}, keywords = {Death, Employment, health policy, Health Services Research, Health Status Indicators, Humans, Insurance Coverage, Life Change Events, Medicaid, Medically Uninsured, Medicare, Middle Aged, Retirement, Spouses, United States}, issn = {0025-7079}, doi = {10.1097/00005650-199802000-00002}, author = {Frank A Sloan and Conover, C.J.} } @article {6575, title = {Health insurance coverage at midlife: characteristics, costs, and dynamics.}, journal = {Health Care Financ Rev}, volume = {18}, year = {1997}, month = {1997 Spring}, pages = {123-48}, publisher = {18}, type = {Journal}, abstract = {

Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.

}, keywords = {Age Factors, Costs and Cost Analysis, Demography, Female, Health Benefit Plans, Employee, Health Care Surveys, Humans, Insurance Coverage, Insurance, Health, Logistic Models, Longitudinal Studies, Male, Middle Aged, United States}, issn = {0195-8631}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194511/}, author = {Richard W. Johnson and Crystal, Stephen} }