TY - JOUR T1 - The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs. JF - Health Serv Res Y1 - 2017 A1 - Geoffrey J Hoffman A1 - Hays, Ron D A1 - Martin F Shapiro A1 - Steven P Wallace A1 - Susan L Ettner KW - Accidental Falls KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Female KW - Financing, Personal KW - Health Expenditures KW - Health Services KW - Humans KW - Male KW - Medicare KW - Models, Econometric KW - Sex Factors KW - Socioeconomic factors KW - United States KW - Wounds and Injuries AB -

OBJECTIVE: To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries.

DATA SOURCES: The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries.

STUDY DESIGN: FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated.

PRINCIPAL FINDINGS: Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion).

CONCLUSIONS: FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.

VL - 52 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27581952?dopt=Abstract ER - TY - JOUR T1 - The Effect of Widowhood on Mental Health - an Analysis of Anticipation Patterns Surrounding the Death of a Spouse. JF - Health Econ Y1 - 2017 A1 - Siflinger, Bettina KW - Adaptation, Psychological KW - Aged KW - Bereavement KW - Cause of Death KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Mental Health KW - Middle Aged KW - Models, Econometric KW - Qualitative Research KW - Spouses KW - Widowhood AB -

This study explores the effects of widowhood on mental health by taking into account the anticipation and adaptation to the partner's death. The empirical analysis uses representative panel data from the USA that are linked to administrative death records of the National Death Index. I estimate static and dynamic specifications of the panel probit model in which unobserved heterogeneity is modeled with correlated random effects. I find strong anticipation effects of the partner's death on the probability of depression, implying that the partner's death event cannot be assumed to be exogenous in econometric models. In the absence of any anticipation effects, the partner's death has long-lasting mental health consequences, leading to a significantly slower adaptation to widowhood. The results suggest that both anticipation effects and adaptation effects can be attributed to a caregiver burden and to the cause of death. The findings of this study have important implications for designing adequate social policies for the elderly US population that alleviate the negative consequences of bereavement. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 26 UR - http://doi.wiley.com/10.1002/hec.3443http://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fhec.3443 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27747997?dopt=Abstract JO - Health Econ. ER - TY - JOUR T1 - Cost of informal caregiving for patients with heart failure. JF - Am Heart J Y1 - 2015 A1 - Heesoo Joo A1 - Fang, Jing A1 - Jan L Losby A1 - Wang, Guijing KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Heart Failure KW - Humans KW - Linear Models KW - Male KW - Middle Aged KW - Models, Econometric AB -

BACKGROUND: Heart failure is a serious health condition that requires a significant amount of informal care. However, informal caregiving costs associated with heart failure are largely unknown.

METHODS: We used a study sample of noninstitutionalized US respondents aged ≥50 years from the 2010 HRS (n = 19,762). Heart failure cases were defined by using self-reported information. The weekly informal caregiving hours were derived by a sequence of survey questions assessing (1) whether respondents had any difficulties in activities of daily living or instrumental activities of daily living, (2) whether they had caregivers because of reported difficulties, (3) the relationship between the patient and the caregiver, (4) whether caregivers were paid, and (5) how many hours per week each informal caregiver provided help. We used a 2-part econometric model to estimate the informal caregiving hours associated with heart failure. The first part was a logit model to estimate the likelihood of using informal caregiving, and the second was a generalized linear model to estimate the amount of informal caregiving hours used among those who used informal caregiving. Replacement approach was used to estimate informal caregiving cost.

RESULTS: The 943 (3.9%) respondents who self-reported as ever being diagnosed with heart failure used about 1.6 more hours of informal caregiving per week than those who did not have heart failure (P < .001). Informal caregiving hours associated with heart failure were higher among non-Hispanic blacks (3.9 hours/week) than non-Hispanic whites (1.4 hours/week). The estimated annual informal caregiving cost attributable to heart failure was $3 billion in 2010.

CONCLUSION: The cost of informal caregiving was substantial and should be included in estimating the economic burden of heart failure. The results should help public health decision makers in understanding the economic burden of heart failure and in setting public health priorities.

PB - 169 VL - 169 UR - http://search.proquest.com/docview/1634498117/abstract/1B5FA0446C27487FPQ/46http://ac.els-cdn.com/S0002870314006176/1-s2.0-S0002870314006176-main.pdf?_tid=0594e8aa-b649-11e5-862d-00000aab0f6bandacdnat=1452286224_94f2bbbda86fc78991ea145942769029http://medi IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25497259?dopt=Abstract U2 - PMC4392718 U4 - Caregivers/Chronic illnesses/Costs/Cardiovascular Diseases/Mortality/Older people/Informal caregiver/Health Care Costs ER - TY - JOUR T1 - The effect of dental insurance on the use of dental care for older adults: a partial identification analysis. JF - Health Econ Y1 - 2015 A1 - Kreider, Brent A1 - Richard J. Manski A1 - John F Moeller A1 - John V Pepper KW - Aged KW - Dental Care KW - Female KW - Humans KW - Insurance Coverage KW - Insurance, Dental KW - Male KW - Middle Aged KW - Models, Econometric KW - Reproducibility of Results AB -

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.

PB - 24 VL - 24 IS - 7 N1 - Export Date: 6 August 2014 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24890257?dopt=Abstract U2 - PMC4247826 U4 - Classification errors/Dental care/Dental insurance/Partial identification/Selection/Treatment effect ER - TY - JOUR T1 - The effects of income on mental health: evidence from the social security notch. JF - J Ment Health Policy Econ Y1 - 2015 A1 - Ezra Golberstein KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Income KW - Male KW - Mental Health KW - Models, Econometric KW - Retirement KW - Sex Factors KW - Social Security KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Mental health is a key component of overall wellbeing and mental disorders are relatively common, including among older adults. Yet the causal effect of income on mental health status among older adults is poorly understood.

AIMS: This paper considers the effects of a major source of transfer income, Social Security retirement benefits, on the mental health of older adults.

METHODS: The Social Security benefit "Notch" is as a large, permanent, and exogenous shock to Social Security income in retirement. The "Notch" is used to identify the causal effect of Social Security income on mental health among older ages using data from the AHEAD cohort of the Health and Retirement Study.

RESULTS: We find that increases in Social Security income significantly improve mental health status and the likelihood of a psychiatric diagnosis for women, but not for men.

DISCUSSION: The effects of income on mental health for older women are statistically significant and meaningful in magnitude. While this is one of the only studies to use plausibly exogenous variation in household income to identify the effect of income on mental health, a limitation of this work is that the results only directly pertain to lower-education households.

IMPLICATIONS: Public policy proposals that alter retirement benefits for the elderly may have important effects on the mental health of older adults.

PB - 18 VL - 18 IS - 1 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25862202?dopt=Abstract U2 - PMC4494112 U4 - mental Health/social Security/older adults/psychiatric diagnosis/household income ER - TY - JOUR T1 - Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals. JF - Health Econ Y1 - 2013 A1 - Padmaja Ayyagari A1 - Deb, Partha A1 - Jason M. Fletcher A1 - William T Gallo A1 - Jody L Sindelar KW - Adult KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Alcoholic Beverages KW - Behavior KW - Body Height KW - Costs and Cost Analysis KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Models, Econometric KW - Socioeconomic factors KW - Taxes KW - United States AB -

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

PB - 22 VL - 22 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22162113?dopt=Abstract U2 - PMC3641566 U4 - Alcohol/Price elasticity/alcohol taxation/Public Policy/Elasticity of demand/heterogeneous policy responses/Fiscal policy/Fiscal policy/latent groups ER - TY - JOUR T1 - Does retirement trigger ill health? JF - Health Econ Y1 - 2012 A1 - Stefanie Behncke KW - Activities of Daily Living KW - Cardiovascular Diseases KW - Chronic disease KW - England KW - Health Status KW - Humans KW - Longitudinal Studies KW - Models, Econometric KW - Neoplasms KW - Quality of Life KW - Retirement KW - Risk Factors AB -

This paper investigates the effects of retirement on various health outcomes. Data stem from the first three waves of the English Longitudinal Study of Ageing (ELSA). With these informative data, non-parametric matching and instrumental variable (IV) methods are applied to identify causal effects. It is found that retirement significantly increases the risk of being diagnosed with a chronic condition. In particular, it raises the risk of a severe cardiovascular disease and cancer. This is also reflected in increased risk factors (e.g. BMI, cholesterol, blood pressure) and increased problems in physical activities. Furthermore, retirement worsens self-assessed health and an underlying health stock.

PB - 21 VL - 21 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21322085?dopt=Abstract U3 - 21322085 U4 - retirement/health/Cross-national/matching methods/instrumental variable/ELSA_ ER - TY - JOUR T1 - The growth in Social Security benefits among the retirement-age population from increases in the cap on covered earnings. JF - Soc Secur Bull Y1 - 2012 A1 - Alan L Gustman A1 - Thomas L. Steinmeier A1 - N. Tabatabai KW - Aged KW - Cohort Studies KW - Female KW - Humans KW - Insurance Benefits KW - Male KW - Middle Aged KW - Models, Econometric KW - Public Policy KW - Salaries and Fringe Benefits KW - Social Security KW - Taxes KW - United States AB -

Analysts have proposed raising the maximum level of earnings subject to the Social Security payroll tax (the "tax max") to improve long-term Social Security Trust Fund solvency. This article investigates how raising the tax max leads to the "leakage" of portions of the additional revenue into higher benefit payments. Using Health and Retirement Study data matched to Social Security earnings records, we compare historical payroll tax payments and benefit amounts for Early Boomers (born 1948-1953) with tax and benefit simulations had they been subject to the tax max (adjusted for wage growth) faced by cohorts 12 and 24 years older. We find that 43.2 percent of the additional payroll tax revenue attributable to tax max increases affecting Early Boomers relative to taxes paid by the cohort 12 years older leaked into higher benefits. For Early Boomers relative to those 24 years older, we find 53.5 percent leakage.

PB - 72 VL - 72 UR - https://www.ssa.gov/policy/docs/ssb/v72n2/v72n2p49.html IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22799138?dopt=Abstract U4 - Social security/payroll tax/Public policy/retirement planning/taxation ER - TY - JOUR T1 - Childhood health and labor market inequality over the life course. JF - J Health Soc Behav Y1 - 2011 A1 - Steven A Haas A1 - M. Maria Glymour A1 - Lisa F Berkman KW - Child KW - Employment KW - Female KW - Health Status KW - Humans KW - Income KW - Male KW - Middle Aged KW - Models, Econometric KW - Retirement KW - Social Class KW - Social Security KW - Socioeconomic factors KW - United States AB -

The authors use data from the Health and Retirement Study's Earnings Benefit File, which links Health and Retirement Study to Social Security Administration records, to estimate the impact of childhood health on earnings curves between the ages of 25 and 50 years. They also investigate the extent to which diminished educational attainment, earlier onset of chronic health conditions, and labor force participation mediate this relationship. Those who experience poor childhood health have substantially diminished labor market earnings over the work career. For men, earnings differentials grow larger over the early to middle career and then slow down and begin to converge as they near 50 years of age. For women, earnings differentials emerge later in the career and show no evidence of convergence. Part of the child health earnings differential is accounted for by selection into diminished educational attainment, the earlier onset of chronic disease in adulthood, and, particularly for men, labor force participation.

PB - 52 VL - 52 IS - 3 N1 - Haas, Steven A Glymour, M Maria Berkman, Lisa F AG023399/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Journal of health and social behavior J Health Soc Behav. 2011;52(3):298-313. doi: 10.1177/0022146511410431. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21896684?dopt=Abstract U3 - 21896684 U4 - chronic Disease/childhood health/labor Force Participation/labor market earnings/labor market earnings/earnings curves/earnings curves ER - TY - JOUR T1 - How does health insurance affect the retirement behavior of women? JF - Inquiry Y1 - 2011 A1 - Kanika Kapur A1 - Jeannette Rogowski KW - Decision making KW - Female KW - Health Benefit Plans, Employee KW - Humans KW - Male KW - Models, Econometric KW - Multivariate Analysis KW - Pensions KW - Retirement KW - Spouses KW - United States KW - Women, Working AB -

The availability of health insurance is a crucial factor in the retirement decision. Women are substantially less likely to have health insurance from their own employment. Using the Health and Retirement Study, we examine the role of employer-provided retiree health insurance in the retirement decisions of single women, and women in single-earner and dual-earner couples. We compare the effect of health insurance on female and male retirement. Our results show that retiree health insurance increases retirement for all groups except single men. We find suggestive evidence that the role of health insurance for women hinges on their husbands' labor force status.

PB - 48 VL - 48 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21634262?dopt=Abstract U3 - 21634262 U4 - Health insurance/Retirement planning/Employee benefits/Impact analysis/Female employees/Life insurance/health insurance/Investment analysis/personal finance/benefits/compensation/Experiment/theoretical treatment ER - TY - JOUR T1 - The impact of private long-term care insurance on the use of long-term care. JF - Inquiry Y1 - 2011 A1 - Yong Li A1 - Gail A Jensen KW - Aged KW - Aged, 80 and over KW - Decision making KW - Female KW - Health Services Accessibility KW - Home Care Services KW - Home Nursing KW - Humans KW - Insurance, Long-Term Care KW - Likelihood Functions KW - Long-term Care KW - Male KW - Models, Econometric KW - Nursing homes KW - Private Sector KW - Regression Analysis KW - United States AB -

This paper investigates the effects of privately purchased long-term care insurance (LTCI) on three major types of long-term care services: nursing home care, paid home care, and informal care received from Family and friends. Using 2002-2008 data from the ongoing Health and Retirement Study, we analyze the determinants of long-term care utilization simultaneously with the determinants of holding LTCI. We find that LTCI has modest effects on the likelihood of using long-term care services. For the very frail elderly, private LTCI enhances their access to nursing home care. For those with moderate disability, LTCI makes it more likely that they can remain at home and receive home care services, instead of going to a nursing home. We find no evidence that formal care substitutes for informal care in the presence of LTCI. These findings suggest that if LTCI becomes much more prevalent in the future, many older adults will be able to choose the type of long-term care arrangement that best suits their needs.

PB - 48 VL - 48 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21634261?dopt=Abstract U3 - 21634261 U4 - Life insurance/health insurance/Experiment/theoretical treatment/Long term care insurance/Impact analysis/Long term health care/Elder care/Health services utilization ER - TY - JOUR T1 - Who pays for obesity? JF - J Econ Perspect Y1 - 2011 A1 - Bhattacharya, Jay A1 - Sood, Neeraj KW - Adult KW - Cost of Illness KW - Financing, Personal KW - Health Benefit Plans, Employee KW - Health Care Costs KW - health policy KW - Humans KW - Income KW - Insurance Coverage KW - Insurance Pools KW - Insurance, Health KW - Life Expectancy KW - Models, Econometric KW - Obesity KW - Prevalence KW - Private Sector KW - Public Sector KW - Risk Adjustment KW - Social Control Policies KW - United States AB -

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—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.

PB - 25 VL - 25 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21598459?dopt=Abstract U3 - 21598459 U4 - Future Elderly Model/obesity/labor force participation/health insurance/public policy/Moral hazard/Public Policy ER - TY - JOUR T1 - Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. JF - Value Health Y1 - 2010 A1 - Zivin, Kara A1 - Scott M Ratliff A1 - Michele M Heisler A1 - Kenneth M. Langa A1 - John D Piette KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Female KW - Financing, Personal KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Medication Adherence KW - Models, Econometric KW - Multivariate Analysis KW - Prescription Fees KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: Although multiple noncost factors likely influence a patient's propensity to forego treatment in the face of cost pressures, little is known about how patients' sociodemographic characteristics, physical and behavioral health comorbidities, and prescription regimens influence cost-related nonadherence (CRN) to medications. We sought to determine both financial and nonfinancial factors associated with CRN in a nationally representative sample of older adults.

METHODS: We used a conceptual model developed by Piette and colleagues that describes financial and nonfinancial factors that could increase someone's risk of CRN, including income, comorbidities, and medication regimen complexity. We used data from the 2004 wave of the Health and Retirement Study and the 2005 HRS Prescription Drug Study to examine the influence of factors within each of these domains on measures of CRN (including not filling, stopping, or skipping doses) in a nationally representative sample of Americans age 65+ in 2005.

RESULTS: Of the 3071 respondents who met study criteria, 20% reported some form of CRN in 2005. As in prior studies, indicators of financial stress such as higher out-of-pocket payments for medications and lower net worth were significantly associated with CRN in multivariable analyses. Controlling for these economic pressures, relatively younger respondents (ages 65-74) and depressive symptoms were consistent independent risk factors for CRN.

CONCLUSIONS: Noncost factors influenced patients' propensity to forego treatment even in the context of cost concerns. Future research encompassing clinician and health system factors should identify additional determinants of CRN beyond patients' cost pressures.

PB - 13 VL - 13 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20070641?dopt=Abstract U2 - PMC3013351 U4 - health Care Costs/socioeconomic Status/cost-related nonadherence/risk factors ER - TY - JOUR T1 - Health and wealth of elderly couples: causality tests using dynamic panel data models. JF - J Health Econ Y1 - 2008 A1 - Pierre-Carl Michaud A1 - Arthur H.O. vanSoest KW - Aged KW - Causality KW - Family Characteristics KW - Female KW - Health Status Indicators KW - Humans KW - Income KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Econometric KW - Retirement KW - Social Class KW - Spouses KW - United States AB -

A positive relationship between socio-economic status (SES) and health, the "health-wealth gradient", is repeatedly found in many industrialized countries. This study analyzes competing explanations for this gradient: causal effects from health to wealth (health causation) and causal effects from wealth to health (wealth or social causation). Using six biennial waves of couples aged 51-61 in 1992 from the US Health and Retirement Study, we test for causality in panel data models incorporating unobserved heterogeneity and a lag structure supported by specification tests. In contrast to tests relying on models with only first order lags or without unobserved heterogeneity, these tests provide no evidence of causal wealth health effects. On the other hand, we find strong evidence of causal effects from both spouses' health on household wealth. We also find an effect of the husband's health on the wife's mental health, but no other effects from one spouse's health to health of the other spouse.

PB - 27 VL - 27 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18513809?dopt=Abstract U2 - PMC2867362 U4 - Wealth/HEALTH/socioeconomic status ER - TY - JOUR T1 - Health status and health dynamics in an empirical model of expected longevity. JF - J Health Econ Y1 - 2008 A1 - Hugo Benítez-Silva A1 - Ni, Huan KW - Chronic disease KW - Delivery of Health Care KW - Empirical Research KW - Female KW - Health Expenditures KW - Health Status KW - Humans KW - Life Expectancy KW - Longevity KW - Male KW - Models, Econometric AB -

Expected longevity is an important factor influencing older individuals' decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman [Grossman, M., 1972. On the concept of health capital and demand for health. Journal of Political Economy 80, 223-255] has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics.

PB - 27 VL - 27 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18187217?dopt=Abstract U2 - PMC2862058 U4 - Longevity/PREDICTIVE MODEL/HEALTH ER - TY - JOUR T1 - Informal care and Medicare expenditures: testing for heterogeneous treatment effects. JF - J Health Econ Y1 - 2008 A1 - Courtney Harold Van Houtven A1 - Edward C Norton KW - Adult KW - Aged KW - Caregivers KW - Health Expenditures KW - Humans KW - Medicare KW - Models, Econometric KW - United States AB -

We estimate the effect of informal care on Medicare expenditures not only for care provided by children but also by the source of informal care (sons versus daughters, children versus others) and recipient characteristics (marital status). Our conceptual framework predicts heterogeneous effectiveness by source and recipient of informal care. We estimate two-part expenditure models as a function of informal care, controlling for endogeneity. We find that informal care by children reduces Medicare long-term care and inpatient expenditures of single elderly. We find that children are less effective caregivers among recipients who are married. For single elderly, child caregivers are more effective than other types. Gender of a child caregiver does not matter.

PB - 27 VL - 27 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17462764?dopt=Abstract U3 - 17462764 U4 - Caregivers/Medicare and Medicaid spending/Marital Status ER - TY - JOUR T1 - Does money buy better health? Unpacking the income to health association after midlife. JF - Health (London) Y1 - 2007 A1 - Berry, Brent M. KW - Aged KW - Attitude to Health KW - Employment KW - Health Status Indicators KW - Humans KW - Income KW - Middle Aged KW - Mobility Limitation KW - Models, Econometric KW - Retirement KW - Self Concept KW - Sociology, Medical KW - United States AB -

This article estimates the effect of household financial resources on health after midlife using models that minimize health-related selectivity and unobserved heterogeneity bias. I focus on the self-rated health and mobility limitations of adults transitioning into retirement over six panels of the Health and Retirement Study (1992-2002; age 51-61 at wave one; N = 7602). Standard regression models that adjust for health-related selection with prospective and retrospective controls suggest a significant influence of long-term income on health, but an insignificant influence of short-term income. Further adjustment for unobserved fixed effects also suggests that short-term income is insignificant. Sizable recent and long-term health feedbacks to income for a portion of the HRS respondents underscore the need to control for the confounding influence of health over the lifecourse. Together these results suggest that adults after midlife are heterogeneous with respect to the causal and selective processes generating the observed association between income and health.

PB - 11 VL - 11 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17344272?dopt=Abstract U4 - HEALTH/income/Wealth ER - TY - JOUR T1 - Lifetime earnings, social security benefits, and the adequacy of retirement wealth accumulation. JF - Soc Secur Bull Y1 - 2005 A1 - Engen, Eric M. A1 - William G. Gale A1 - Cori E. Uccello KW - Adult KW - Humans KW - Income KW - Middle Aged KW - Models, Econometric KW - Pensions KW - Retirement KW - Social Security KW - United States PB - 66 VL - 66 UR - https://www.ssa.gov/policy/docs/ssb/v66n1/v66n1p38.html IS - 1 N1 - Revision of CRR Working Paper 2004-10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16295316?dopt=Abstract U4 - Social Security expectations/Retirement Saving ER - TY - JOUR T1 - The effect of the tobacco settlement and smoking bans on alcohol consumption. JF - Health Econ Y1 - 2004 A1 - Gabriel A. Picone A1 - Frank A Sloan A1 - Justin G Trogdon KW - Aged KW - Alcohol Drinking KW - Behavior, Addictive KW - Data collection KW - Female KW - Humans KW - Male KW - Middle Aged KW - Models, Econometric KW - Smoking KW - United States AB -

In the last few years, the price of cigarettes has increased considerably in the USA. In addition, a number of states have also imposed smoking bans. These increases in the cost and barriers to smoking have created a natural experiment to study relationships between smoking and drinking behaviors. In this study, we employ data from the first six waves of the Health and Retirement Survey (HRS) to analyze the effects of smoking bans and cigarette prices on alcohol consumption. We also test if past cigarette and alcohol consumption affect current alcohol consumption as predicted by co-addiction models. We estimate dynamic panel models using GMM estimators. Our approach allows us to obtain consistent estimates irrespective of the number of time periods. The three main findings of this study are: (1) there is positive reinforcement effect of past cigarette consumption on current alcohol consumption, (2) smoking bans reduce alcohol consumption and (3) there is a positive effect of cigarette prices on alcohol consumption.

PB - 13 VL - 13 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15386690?dopt=Abstract U4 - Smoking/Alcohol Drinking ER - TY - JOUR T1 - Breast cancer survival, work, and earnings. JF - J Health Econ Y1 - 2002 A1 - Cathy J. Bradley A1 - Bednarek, Heather A1 - David Neumark KW - Breast Neoplasms KW - Cohort Studies KW - Diagnostic Tests, Routine KW - Efficiency KW - Employment KW - Female KW - Humans KW - Longitudinal Studies KW - Mammography KW - Middle Aged KW - Models, Econometric KW - Probability KW - Research Design KW - Retirement KW - Salaries and Fringe Benefits KW - Social Security KW - Survivors KW - United States KW - Women, Working AB -

Relying on data from the Health and Retirement Study (HRS) linked to longitudinal social security earnings data, we examine differences between breast cancer survivors and a non-cancer control group in employment, hours worked, wages, and earnings. Overall, breast cancer has a negative impact on employment. However, among survivors who work, hours of work, wages, and earnings are higher compared to women in the control group. We explore possible biases underlying these estimates, focusing on selection, but cannot rule out a causal interpretation. Our research points to heterogeneous labor market responses to breast cancer, and shows that breast cancer does not appear to be debilitating for women who remain in the work force.

PB - 21 VL - 21 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12349881?dopt=Abstract U4 - Breast Neoplasms/Economics/Mortality/Radiography/Cohort Studies/Diagnostic Tests, Routine/Efficiency/Employment/Economics/Statistics and Numerical Data/Female/Human/Longitudinal Studies/Mammography/Utilization/Middle Age/Models, Econometric/Probability/Research Design/Retirement/Salaries and Fringe Benefits/Statistics and Numerical Data/Social Security/Support, U.S. Government--PHS/Survivors/Statistics and Numerical Data/United States/Epidemiology/Women, Working/Statistics and Numerical Data ER - TY - JOUR T1 - The effect of smoking on health using a sequential self-selection model. JF - Health Econ Y1 - 2000 A1 - Kajal Chatterji Lahiri A1 - Song, Jae G. KW - Adult KW - Aged KW - Aged, 80 and over KW - Attitude to Health KW - Decision making KW - Health Behavior KW - Health Status KW - Health Surveys KW - Humans KW - Middle Aged KW - Models, Econometric KW - Predictive Value of Tests KW - Reproducibility of Results KW - Risk Factors KW - Risk-Taking KW - Selection Bias KW - Smoking KW - Smoking cessation KW - Surveys and Questionnaires KW - United States AB -

We estimate a structural model of individual smoking behaviour emphasizing the role of individual risk belief on smoking choices. Our model consists of five equations: two selection equations for initiation and cessation decisions, and three switching outcome regressions for nonsmokers, ex-smokers, and current smokers. The presence of significant self-selectivity implies that the health effects of smoking based on sample proportions do not correctly indicate the true risk of cigarette smoking. Further, our evidence suggests that the self-selection in the cessation decision, but not in the initiation decision, is consistent with economic rationality. We estimate the model by full information maximum likelihood (FIML) with starting values from heteroskedasticity corrected Heckman-Lee two-step method using newly released Health and Retirement Study (HRS) data.

PB - 9 VL - 9 IS - 6 N1 - ProCite field 3 : SUNY, Albany; SUNY, Albany U1 - http://www.ncbi.nlm.nih.gov/pubmed/10983003?dopt=Abstract U4 - Economic Status/Health Production/Nutrition/Mortality/Morbidity/Disability/Disability/Economic Behavior/Smoking ER - TY - JOUR T1 - Uninsured status and out-of-pocket costs at midlife. JF - Health Serv Res Y1 - 2000 A1 - Richard W. Johnson A1 - Crystal, Stephen KW - Age Factors KW - Female KW - Financing, Personal KW - Health Care Surveys KW - Health Services KW - Health Status KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Middle Aged KW - Models, Econometric KW - Multivariate Analysis KW - Surveys and Questionnaires KW - United States AB -

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.

PB - 35 VL - 35 IS - 5 Pt 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11130804?dopt=Abstract U4 - Age Factors/Comparative Study/Female/Financing, Personal/Statistics and Numerical Data/Health Care Surveys/Health Services/Economics/Utilization/Health Status/Insurance Coverage/Insurance, Health/Longitudinal Studies/Medically Uninsured/Middle Age/Models, Econometric/Multivariate Analysis/Questionnaires/Support, Non U.S. Government/United States ER - TY - JOUR T1 - Demographic and economic correlates of health in old age. JF - Demography Y1 - 1997 A1 - James P Smith A1 - Raynard Kington KW - Activities of Daily Living KW - Aged KW - Cohort Studies KW - Demography KW - Disabled Persons KW - ethnicity KW - Female KW - Health Status KW - Humans KW - Income KW - Male KW - Models, Econometric KW - Racial Groups KW - Socioeconomic factors KW - United States AB -

In this paper we examine disparities in the ability to function among older Americans. We place special emphasis on two goals: (1) understanding the quantitatively large socioeconomic status-health gradient, and (2) the persistence in health outcomes over long periods. We find that there exist strong contemporaneous and long-run feedbacks from health to economic status. In light of these feedbacks, it is important to distinguish among alternative sources of income and the recipient of income in the household. This research also demonstrates that health outcomes at old age are influenced by health attributes of past, concurrent, and future generations of relatives. Finally, we find that the demographic and economic differences that exist among them explain functional health disparities by race and ethnicity, but not by gender.

PB - 34 VL - 34 UR - https://www.ncbi.nlm.nih.gov/pubmed/9074837 IS - 1 N1 - ProCite field 3 : RAND; UCLA and RAND U1 - http://www.ncbi.nlm.nih.gov/pubmed/9074837?dopt=Abstract U4 - Economics of the Elderly/Health Status/Socioeconomic Status/Ethnicity/Income/Gender/Old Age ER -