Using the Health and Retirement Study for Research on the Impact of the Working Conditions on the Individual Life Course.

The aim of this paper is to evaluate the utility of the Health and Retirement Study (HRS) for studying the impact of working conditions on individuals' health, well-being and labor supply decisions at older ages. I provide a brief overview of the information on working conditions that is currently available in the HRS and discuss implications for studies on the effects of working conditions on the individual life course. I conclude with a discussion of how recent and projected trends in the U.S. workforce are reflected in the current HRS survey content.

The effect of economic conditions on the disability insurance program: Evidence from the great recession.

We examine the effect of job displacement during the Great Recession on the Social Security Disability Insurance (SSDI) program. Exploiting variation in the severity and timing of the recession across states, we estimate the effect of unemployment on SSDI applications and awards. We find the Great Recession induced nearly one million SSDI applications that otherwise would not have been filed, of which 41.8% were awarded benefits, resulting in over 400,000 new beneficiaries who made up 8.9% of all SSDI entrants between 2008 and 2012. More than one-half of the recession-induced awards were made on appeal. The induced applicants had less severe impairments than the average applicant. Only 9% had the most severe, automatically-qualifying impairments, 33% had functional impairments and no transferable skills, and the rest were denied for having insufficiently severe impairments and/or transferable skills. Our estimates imply the Great Recession increased claims processing costs by $2.960 billion during 2008-2012, and SSDI benefit obligations by $55.730 billion in present value, or $97.365 billion including both SSDI and Medicare benefits.

How Much Do Outside Options Matter? The Effect of Subsidized Health Insurance on Social Security Disability Insurance Benefit Receipt.

New government health insurance programs may affect participation in existing safety-net benefits that provide health insurance as a secondary aim. We examine whether the outside options for health insurance made available by the Affordable Care Act affected Social Security Disability Insurance (DI) application decisions. Using the universe of U.S. individual income tax records spanning 2007-2016, we first estimate the effect of Medicaid expansions using a state difference-in-differences identification strategy, but find small and statistically insignificant estimates. However, when we estimate the effect of being eligible for high vs. low Marketplace subsidies based on geography, we find some evidence consistent with subsidies increasing DI claiming among those with prior access to Employer Sponsored Insurance, and decreasing DI claiming otherwise. Overall, we find suggestive evidence that outside options for health insurance do matter, though magnitudes are small and results are statistically precise only for Marketplace coverage.

Unmet Need for Workplace Accommodation.

We use experimental survey methods in a nationally representative survey to test alternative ways of identifying (1) individuals in the population who would be better able to work if they received workplace accommodation for a health condition; (2) the rate at which these individuals receive workplace accommodation; and (3) the rate at which accommodated workers are still working four years later, compared to similar workers who were not accommodated. We find that question order in disability surveys matters. We present suggestive evidence of priming effects that lead people to understate accommodation when first asked about work-limiting health problems. We also find a sizeable fraction of workers who report they receive a workplace accommodation for a health problem but do not report work limitations per se. Our preferred estimate of the size of the accommodation-sensitive population is 22.8 percent of all working age adults. We find that 47-58 percent of accommodation-sensitive individuals lack accommodation and would benefit from some kind of employer accommodation to either sustain or commence work. Finally, among accommodation-sensitive individuals, workers who were accommodated for a health problem in 2014 were 13.2 percentage points (18.5 percent) more likely to work in 2018 than those who were not accommodated in 2014.

Employer Accommodation and Labor Supply of Disabled Workers.

We examine the factors that influence employer accommodation of newly disabled workers and how effective such accommodations are in retaining workers and discouraging disability insurance applications. Using the Health and Retirement Study, we find that only a quarter of newly disabled older workers in their 50s are accommodated by their employers in some way following onset of a disability. Importantly, we find that few employer characteristics explain which workers are accommodated; rather, employee characteristics, particularly the presence of personality traits correlated with assertiveness and open communication, are highly predictive of accommodation. We also find that if employer accommodation rates could be increased, disabled workers would be significantly more likely to delay labor force exit for up to two years. However, accommodation does not appear to reduce subsequent disability insurance claiming.

Disability Benefit Generosity and Labor Force Withdrawal.

A key component for estimating the optimal size and structure of disability insurance (DI) programs is the elasticity of DI claiming with respect to benefit generosity. Yet, in many countries, including the United States, all workers face identical benefit schedules, which are a function of one's labor market history, making it difficult to separate the effect of the benefit level from the effect of unobserved preferences for work on individuals' claiming decisions. To circumvent this problem, we exploit exogenous variation in DI benefits in Austria arising from several reforms to its DI and old age pension system in the 1990s and 2000s. We use comprehensive administrative social security records data on the universe of Austrian workers to compute benefit levels under six different regimes, allowing us to identify and precisely estimate the elasticity of DI claiming with respect to benefit generosity. We find that, over this time period, a one percent increase in potential DI benefits was associated with a 1.2 percent increase in DI claiming.

POLICY VARIATION, LABOR SUPPLY ELASTICITIES, AND A STRUCTURAL MODEL OF RETIREMENT.

This paper exploits a combination of policy variation from multiple pension reforms in Austria and administrative data from the Austrian Social Security Database. Using the policy changes for identification, we estimate social security wealth and accrual elasticities in individuals' retirement decisions. Next, we use these elasticities to estimate a dynamic programming model of retirement decisions. Finally, we use the estimated model to examine the labor supply and welfare consequences of potential social security reforms.

Monetary costs of dementia in the United States.

BACKGROUND: Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase. METHODS: In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers. RESULTS: The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost. CONCLUSIONS: Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.).

What Explains the Gender Gap in Financial Literacy? The Role of Household Decision Making.

Using newly collected data from the RAND American Life Panel, we examine potential explanations for the gender gap in financial literacy, including the role of marriage and who within a couple makes the financial decisions. Blinder-Oaxaca decomposition reveals the majority of the gender gap in financial literacy is not explained by differences in the characteristics of men and women-but rather differences in coefficients, or how literacy is produced. We find that financial decision making of couples is not centralized in one spouse although it is sensitive to the relative education level of spouses.

Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services.

Performance-based accountability systems (PBASs), which link incentives to measured performance as a means of improving services to the public, have gained popularity. While PBASs can vary widely across sectors, they share three main components: goals, incentives, and measures. Research suggests that PBASs influence provider behaviors, but little is known about PBAS effectiveness at achieving performance goals or about government and agency experiences. This study examines nine PBASs that are drawn from five sectors: child care, education, health care, public health emergency preparedness, and transportation. In the right circumstances, a PBAS can be an effective strategy for improving service delivery. Optimum circumstances include having a widely shared goal, unambiguous observable measures, meaningful incentives for those with control over the relevant inputs and processes, few competing interests, and adequate resources to design, implement, and operate the PBAS. However, these conditions are rarely fully realized, so it is difficult to design and implement PBASs that are uniformly effective. PBASs represent a promising policy option for improving the quality of service-delivery activities in many contexts. The evidence supports continued experimentation with and adoption of this approach in appropriate circumstances. Even so, PBAS design and its prospects for success depend on the context in which it will operate. Also, ongoing system evaluation and monitoring are integral components of a PBAS; they inform refinements that improve system functioning over time. Empirical evidence of the effects of performance-based public management is scarce. This article also describes a framework used to evaluate a PBAS. Such a system identifies individuals or organizations that must change their behavior for the performance of an activity to improve, chooses an implicit or explicit incentive structure to motivate these organizations or individuals to change, and then chooses performance measures tailored to inform the incentive structure appropriately. The study focused on systems in the child care, education, health care, public health emergency preparedness, and transportation sectors, mainly in the United States. Analysts could use this framework to seek empirical information in other sectors and other parts of the world. Additional empirical information could help refine existing PBASs and, more broadly, improve decisions on where to initiate new PBASs, how to implement them, and then how to design, manage, and refine them over time.

Can you get what you pay for? Pay-for-performance and the quality of healthcare providers.

Despite the popularity of pay-for-performance (P4P) among health policymakers and private insurers as a tool for improving quality of care, there is little empirical basis for its effectiveness. We use data from published performance reports of physician medical groups contracting with a large network HMO to compare clinical quality before and after the implementation of P4P, relative to a control group. We consider the effect of P4P on both rewarded and unrewarded dimensions of quality. In the end, we fail to find evidence that a large P4P initiative either resulted in major improvement in quality or notable disruption in care.