TY - RPRT T1 - Health Status, Insurance, and Expenditures in the Transition from Work to Retirement Y1 - 2005 A1 - Hugo Benítez-Silva A1 - Boz, Emine A1 - Buchinsky, Moshe A1 - Nichols, Joseph B. A1 - Roy, Sharbani A1 - Rust, John A1 - Tristao, Ignez KW - Health Conditions and Status KW - Insurance AB - This paper analyzes the dynamics of health insurance coverage, health expenditures, and health status in the decade expanding from 1992 to 2002, for a cohort of older Americans. We follow 13,594 individuals interviewed in Waves 1 to 6 of the Health and Retirement Study, most of whom were born between 1930 and 1940, as they transition from work into retirement. Although this depression cohort is by and large fairly well prepared for retirement in terms of pension coverage and savings, we identify significant gaps in their health insurance coverage, especially among the most disadvantaged members of this cohort. We find that government health insurance programs particularly Medicare and Medicaid significantly reduce the number of individuals who are uninsured and the risks of large out of pocket health care costs. However, prior to retirement large numbers of these respondents were uninsured, nearly 18 at the first survey in 1992. Moreover, a much larger share, about 55 of this cohort, are transitorily uninsured, that is, they experience one or more spells, lasting from several months to several years, without health insurance coverage. We also identify a much smaller group of persistently uninsured individuals, and show that this group has significantly less wealth, and higher rates of poverty, unemployment, and health problems, disability, and higher mortality rates than the rest of the members of the cohort under study. We provide evidence that lack of health insurance coverage is correlated with reduced utilization of health care services; for example, respondents with no health insurance visit the doctor one fourth as often as those with private insurance and are also more likely to report declines in health status. We also analyze the components of out of pocket health care costs, and show that prescription drug costs constituted a rapidly rising share of the overall cost of health care during the period of analysis. JF - ERIU Working Paper PB - Economic Research Initiative on the Uninsured, University of Michigan CY - Ann Arbor, MI UR - http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.478.8454&rep=rep1&type=pdf U4 - Health Status/Insurance/Health Expenditures ER - TY - JOUR T1 - How Large is the Bias in Self-Reported Disability? JF - Applied Econometrics Y1 - 2004 A1 - Hugo Benítez-Silva A1 - Buchinsky, Moshe A1 - Hiu-Man Chan A1 - Sheidvasser, Sofia A1 - Rust, John KW - Disabilities KW - Methodology KW - Social Security AB - A pervasive concern with the use of self-reported health and disability measures in behavioral models is that they are biased and endogenous. A commonly suggested explanation is that survey respondents exaggerate the severity of health problems and incidence of disabilities in order to rationalize labor force non-participation, application for disability benefits and/or receipt of those benefits. This paper re-examines this issue using a self-reported indicator of disability status from the Health and Retirement Survey. Using a bivariate probit model we test and are unable to reject the hypothesis that the self-reported disability measure is an exogenous explanatory variable in a model of individual's decision to apply for DI benefits or Social Security Administration's decision to award benefits. We further study a subsample of individuals who applied for Disability Insurance and Supplemental Security Income benefits from the Social Security Administration (SSA) for whom we can also observe SSA's award/deny decision. For this subsample we test and are unable to reject the hypothesis that self-reported disability is health and socio-economic characteristics similar to the information used by the SSA in making its award decisions. The unbiasedness restriction implies that these two variables have the same conditional probability distributions. Thus, our results indicate that disability applicant do not exaggerate their disability status at least in anonymous surveys such as the HRS. Indeed, our results are consistent with the hypothesis that disability applicants are aware of the criteria and decision rules that SSA uses in making awards and act as if they were applying these same criteria and rules when reporting their own disability status. PB - 19 VL - 19 IS - 6 N1 - NIH Grant AG12985-02 // la Caixa Fellowship Program // Alfred P. Sloan Research Fellowship U4 - Social Security/Disability/Disability/Conditional Moment Tests ER - TY - RPRT T1 - How Large Are the Classification Errors in the Social Security Disability Award Process? Y1 - 2003 A1 - Hugo Benítez-Silva A1 - Buchinsky, Moshe A1 - Rust, John KW - Disabilities KW - Methodology KW - Social Security AB - This paper presents an audit of the multistage application and appeal process that the U.S. Social Security Administration (SSA) uses to determine eligibility for disability benefits of the Disability Insurance (DI) and Supplemental Security Income (SSI) programs. We study a subset of individuals from the Health and Retirement Survey (HRS) who applied for DI or SSI benefits between 1992 and 1996. We compare the SSA s ultimate award decision a (i.e., after allowing for all possible appeals) to the applicant s self-reported disability status d (recorded at the first HRS survey after their initial application for benefits). We use these data to estimate classification error rates under the hypothesis that applicants self-reported disability status d is the relevant measure of true disability and the SSA s ultimate award decision a is a noisy but unbiased indicator of d This truthful, accurate reporting hypothesis allows us to estimate the magnitude of classification errors in the SSA award process and obtain insights into the patterns of self-selection induced by varying delays and award probabilities at various levels of the application and appeal process. Overall we find that 22 of SSI/DI applicants who are ultimately awarded benefits are not disabled, and that 59 of applicants who were denied benefits are disabled. We construct a computerized disability screening rule using a subset of objective health indicators that the SSA uses in making award decisions that results in significantly lower classification error rates than does SSA s current award process. This suggests that there may be cheaper, faster, and more accurate ways to make disability determinations than the SSA s current disability award process. We also estimate classification errors under the assumption that both a and d are noisy but unbiased indicators of an (unobserved) underlying indicator of true disability, t . However, the estimated classification error rates remain virtually unchanged under this alternative hypothesis. PB - SUNY-Stony Brook UR - http://ms.cc.sunysb.edu/ hbenitezsilv/dice.pdf N1 - NIH Grant AG12985-02 U4 - Social Security/Disability/Disability/Classification errors ER - TY - RPRT T1 - Modeling Behavioral Responses to Changes in Social Security: A Life-Cycle Framework Y1 - 2001 A1 - Rust, John KW - Event History/Life Cycle KW - Social Security AB - The life cycle model can be used to provide detailed predictions of the behavioral responses to wide range of hypothetical changes in Social Security policy. I provide a concrete illustration of how this is done by using a preliminary calibrated version of the life cycle model to predict the behavioral responses of a change in the Social Security Disability Insurance (SSDI) program known internally within the Social Security Administration as the 1 for 2 benefit offset proposal . PB - University of Maryland U4 - Life Cycle Models/Social Security Disability Insurance ER - TY - JOUR T1 - Effect of Pensions on Saving: Analysis with Data from the Health and Retirement Study: A Comment JF - Carnegie Rochester Conference Series on Public Policy Y1 - 1999 A1 - Rust, John KW - Consumption and Savings KW - Employment and Labor Force KW - Income KW - Pensions KW - Retirement Planning and Satisfaction KW - Social Security PB - 50 VL - 50 IS - 99 U4 - Retirement/Retirement Policies/Personal Income and Wealth Distribution/Nonwage Labor Costs and Benefits/Private Pensions/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Social Security and Public Pensions/Pension/Retirement/Saving ER - TY - JOUR T1 - An Empirical Analysis of the Social Security Disability Application, Appeal, and Award Process JF - Labour Economics Y1 - 1999 A1 - Hugo Benítez-Silva A1 - Buchinsky, Moshe A1 - Hiu-Man Chan A1 - Rust, John A1 - Sheidvasser, Sofia KW - Disabilities KW - Employment and Labor Force KW - Health Conditions and Status KW - Net Worth and Assets KW - Social Security AB - This paper uses the first three waves of the HRS to provide an empirical analysis of the Social Security disability application, award, and appeal process. PB - 6 VL - 6 IS - 2 U4 - Economic Status/Labor/Health Status/Disability/Disability/Social Security ER - TY - RPRT T1 - Evaluation of the HRS and RHS from a Decision-Theoretic Perspective Y1 - 1993 A1 - Rust, John KW - Methodology AB - This paper has 3 objectives: 1) it presents a structural econometric DP model of retirement behavior that requires extensive datasets such as RHS and HRS, 2) it evaluates the pros and cons of the overall survey design of the RHS and HRS from the standpoint of a person interested in estimating a DP model, and 3) it provides a comparative data analysis of key variables in the RHS and HRS. The results of the data analysis indicate that relative to the RHS male primary respondents work less, have substantially higher total family income (but not much higher labor income) and are significantly more likely to apply for Social Security early retirement benefits at age 62. Part of the reason why total family income has increased much more than labor income of male primary respondents is due to increased labor force participation on the part of the spouse. Levels of education and home ownership are significantly higher in the HRS, and the housing continues to remain the predominant component of family net worth. PB - University of Michigan UR - http://www.psc.isr.umich.edu/pubs/series.html U4 - HRS content and design ER -