[Show abstract][Hide abstract] ABSTRACT: Objective
To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans.Data Sources/Study SettingWe used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS).Study DesignWe compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured.Data Collection/Extraction Methods
The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ).Principal FindingsWe found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older.Conclusions
Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users.
Health Services Research 07/2014; 50(1). DOI:10.1111/1475-6773.12205 · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
We analyzed correlates of older Americans' continuous and transitional health care utilization over 4 years.
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.
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.
Older individuals' 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.
American Journal of Public Health 05/2013; 103(7). DOI:10.2105/AJPH.2012.301124 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Medicaid Buy-In (Buy-In) program allows people with disabilities to "buy into" Medicaid when their earnings or assets would typically make them ineligible. This program may be advantageous to youth with psychiatric disabilities by providing continuous health care coverage while they are employed.
State-submitted participant-level Buy-In enrollment data were linked with Social Security Administration data to identify the receipt of federal disability benefits, the primary disability used to determine eligibility, and annual earnings. We assessed the differences in employment outcomes between young participants (ages 18 to 30) with psychiatric disabilities versus young participants with other disabilities, including the likelihood of being employed, average earnings, and changes in earnings around the time of Buy-In enrollment.
Young Buy-In participants with psychiatric disabilities were just as likely to be employed as those with other disabling conditions, although their average earnings were slightly lower. Both groups were similarly likely to increase their earnings around the time of Buy-In enrollment, but among participants who had such increases, the amount of the increase was higher for those with psychiatric disabilities.
Young Buy-In participants with psychiatric disabilities achieve larger average increases in earnings around the time of enrollment in the program than those with other disabling conditions, though average earnings while employed are lower. This suggests that the coverage provided by Buy-In may be particularly beneficial for youth with psychiatric disabilities. Outreach to enroll these youth into the program may benefit this vulnerable group, who often lack other supports in the community.
[Show abstract][Hide abstract] ABSTRACT: Objective:
The purpose of this article is to examine the relationship between changes in household finances (wealth and income) and changes in dental utilization at the onset of the recent recession in a population of older Americans.
Data from the Health and Retirement Study (HRS) were analyzed for U.S. individuals aged 51 years and older during the 2006 and 2008 waves of the HRS. We estimated logistic models of (a) starting and (b) stopping dental use between 2006 and 2008 survey periods as a function of changes in household wealth and income, controlling for other potentially confounding covariates.
We found that only when household wealth falls by 50 percent or more were older adults less likely to seek dental care. Changes in household income and other changes in household wealth were not associated with changes in dental utilization among this population.
Older Americans' dental care utilization appeared to be fairly resilient to changes in household finances; only when wealth fell by 50 percent or more did individuals decrease dental use. This finding might extend to other health-care services that are preventive, routine, and relatively inexpensive.
Journal of Public Health Dentistry 09/2012; 74(1). DOI:10.1111/j.1752-7325.2012.00370.x · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This analysis used propensity score matching to construct a comparison sample that is observationally similar at baseline interview to older workers who later experience the onset of a medical condition that limits their ability to work. Using these matched onset and comparison samples, we studied trajectories in earnings and income around onset of the work limitation. Earnings two years after onset for the work-limitation group were 50% lower and poverty rates were nearly double. Income from unemployment insurance, workers' compensation, and retirement and disability benefits offset only a small amount of the earnings declines, resulting in decreased overall household income after onset of the work-limiting condition.
Inquiry: a journal of medical care organization, provision and financing 08/2012; 49(2):141-63. DOI:10.2307/23480908 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to examine the relationship of wealth and income and the relative impact of each on dental utilization in a population of older Americans, using data from the Health and Retirement Study (HRS).
Data from the HRS were analyzed for US individuals aged 51 years and older during the 2008 wave of the HRS. The primary focus of the analysis is the relationship between wealth, income, and dental utilization. We estimate a multivariable model of dental use controlling for wealth, income, and other potentially confounding covariates.
We find that both wealth and income each have a strong and independent positive effect on dental care use of older Americans (P < 0.05). A test of the interaction between income and wealth in our model failed to show that the impact on dental care utilization as wealth increases depends on a person's income level or, alternatively, that the impact on dental use as income increases depends on a person's household wealth status (P > 0.05).
Relative to those living in the wealthiest US households, the likelihood of utilizing dental care appears to decrease with a decline in wealth. The likelihood of utilizing dental care also appears to decrease with a decline in income as well.
Journal of Public Health Dentistry 04/2012; 72(3):179-89. DOI:10.1111/j.1752-7325.2012.00312.x · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fewer Social Security Disability Insurance (DI) beneficiaries have their earnings suspended or terminated because of work than those who are actually working, partly because beneficiaries "park" earnings at a level below substantial gainful activity (SGA) to retain benefits. We assess the extent of parking by exploiting the 1999 change in the SGA earnings level from $500 to $700 monthly for nonblind beneficiaries using a difference-indifference analysis that compares two annual cohorts of beneficiaries who completed their trial work period, one that was affected by the SGA change and one that was not. Our impact estimates, along with results from other sources, suggest that from 0.2 to 0.4 percent of all DI beneficiaries were parked below the SGA level in the typical month from 2002 through 2006. The SGA change did not yield any difference in mean earnings, although it did result in a small reduction in months spent off of the rolls because of work.
[Show abstract][Hide abstract] ABSTRACT: Anecdotal evidence suggests that Social Security Disability Insurance (SSDI) beneficiaries intentionally restrain, or â€œpark,â€ their earnings at a level below substantial gainful activity to retain cash benefits. But empirical evidence documenting such behavior is scant. This article in Social Security Bulletin looks at the impact of the 1999 change in the substantial gainful activity earnings level on two cohorts of SSDI beneficiariesâ€”one affected by the change and one not. The results show that in a typical month from 2002 through 2006, between 0.2 to 0.4 percent of all SSDI beneficiaries were parked below the substantial gainful activity level in a typical month.
[Show abstract][Hide abstract] ABSTRACT: We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status.
We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates.
We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods.
Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health.
American Journal of Public Health 08/2011; 101(10):1882-91. DOI:10.2105/AJPH.2011.300227 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We use a new variable in the Social Security Administration's Ticket Research File to produce statistics on the first month of suspension or termination for work (STW) for Social Security Disability Insurance (DI) and Supplemental Security Income (SSI)-only beneficiaries as well as on the number of months in nonpayment status following suspension or termination for work (NSTW) before their return to the rolls, attainment of the full retirement age, or death--in each year from 2002 through 2006. Less than 1 percent of beneficiaries experienced their first STW in each year, but more were in NSTW in at least 1 month. Ticket to Work (TTW) participants were more likely to have a first STW than nonparticipants, but most of those who had an STW were not TTW participants, reflecting low use of TTW. Employment networks often failed to file claims for outcome payments during months when their TTW clients were in NSTW.
[Show abstract][Hide abstract] ABSTRACT: Many proposals designed to reduce federal budget deficits include retirement policy reforms that would delay workers??? access to retirement benefits or reduce the value of benefits to those who retire early. Such reforms would have adverse consequences for the economic well-being of older workers with health-related work limitations. In this paper, we explore a set of policy options that take a "work-support" approach-an earned income tax credit (EITC), an employment services allowance, and a health insurance subsidydesigned to encourage and help workers continue to work if they can.
To arrive at a population that might be eligible for such benefits, we first develop a straightforward model to predict the likelihood that a worker reporting a health-related work limitation would experience economic hardship as a result. The model bounds the target population by excluding those who are not expected to experience financial hardship from earnings loss due to a health-related work limitation. It also demonstrates an approach to eligibility determination that would discourage gaming and support rapid eligibility determination-critical for a program designed to extend employment and prevent financial
Using conservative assumptions about program costs, our most expensive program would have a per capita cost of $14,600, or $11,300 if the health insurance subsidy is viewed as an ACA cost. This can be compared to estimated mean annual benefits of $14,855 in 2009 for Social Security Disability Insurance (SSDI) beneficiaries age 50 and older, plus $11,000 per year for Medicare after the 24-month waiting period. Because of its more favorable work incentives, a work-support program is likely to reduce hardship more than a program that preserves existing benefits for the same workers at comparable cost and is likely to be no more difficult to administer.
[Show abstract][Hide abstract] ABSTRACT: Fewer Social Security Disability Insurance (DI) beneficiaries have their earnings suspended or terminated because of work than those who are actually working, partly because beneficiaries "park" earnings at a level below substantial gainful activity (SGA) to retain benefits. We assess the extent of parking by examining how beneficiary earnings and months off the rolls for work responded to a 1999 change in the SGA level for non-blind beneficiaries from $500 to $700 per month. Specifically, our difference-in-difference analysis compares longitudinal data for two beneficiary cohorts with different incentives to park their earnings; one experienced the increased SGA level the first year after its Trial Work Period (TWP), when beneficiaries can earn any amount without losing benefits, while the two-year-earlier cohort did not. The impact of the increased SGA level is consistent with parking, but its magnitude small. The reduction in TWP completers with earnings less than $500 was 1.0 percentage points, the reduction in the percentage with earnings over $700 was 1.2 percentage points, and the increase for those with earnings between $500 and $700 was 2.2 percentage points. However, there was no change in mean earnings; small increases for those with relatively low earnings were offset by reductions for those with relatively high earnings. The SGA increase had a significant negative effect on the average number of months that beneficiaries were off the rolls for work; the effect was largest-about six-tenths of a month-for those who earned $500 to $700 during in year they completed their TWP. Social Security Administration
[Show abstract][Hide abstract] ABSTRACT: After the onset of a health condition that limits one’s ability to work, many suffer large losses in earnings and household income. These losses may be most prevalent among older workers, who are more at risk for the onset of new health conditions. Some of the resulting earnings losses may be offset by receipt of unemployment insurance, worker’s compensation, or public programs such as Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Social Security retirement (SSR). However, the extent to which these other sources are able to offset earnings losses and protect older workers from poverty is not fully known.Evidence from previous work indicates that the onset of health-related work limitations has significant negative effects on labor supply, leading to depressed earnings, lower household income despite increases in public and private benefits, and decreased wealth accumulation. But, the majority of earlier studies rely on fixed effects methods to identify how an individual’s income deviates from its pre-onset trajectory. As individuals near retirement age however, one’s pre-onset earnings trajectory may not accurately reflect the path that earnings would have followed in the absence of work-limitation onset. For example, if households had been planning on retiring but then experienced a health-related work limitation, estimates from the existing studies would overstate the effect of work-limitations on earnings and household income losses by assuming the pre-onset trajectory continued.To better measure the counterfactual of how individual earnings and household incomes would have evolved without work-limitation onset, we carefully constructed a comparison group using propensity score matching methods. Using data from the Health and Retirement Study (HRS), we identify individuals who experience work-limitation onset after their baseline interview and match them to those who do not experience onset. Our matching method uses a battery of demographic, socioeconomic, and employment-related characteristics that may affect the likelihood of experiencing onset and income trajectories to predict the time to disability onset. Using the long panel of data in the HRS, we are able to use our matched treatment and comparison samples to assess how various sources of income evolve after work-limitation onset compared to what they would have been in the absence of onset.Preliminary findings show that earnings losses after work-limitation onset are large and are not fully offset by other sources of income. Holding sex, baseline marital status, and eligibility for Social Security Retirement (SSR) constant, mean earnings four years after onset for the work limitation onset group are 70 percent lower than for the comparison group. Mean unemployment, workers’ compensation, disability insurance, and retirement benefits for the work limitation group are higher after onset than in the comparison group, but on average they offset less than 30 percent of the earnings difference. Post-onset poverty is 6 to 12 percentage points higher among those experiencing onset; eligibility for SSR at age 62 buffers some of this increased risk of poverty.
[Show abstract][Hide abstract] ABSTRACT: 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).
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.
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.
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.
Journal of Public Health Dentistry 12/2009; 70(2):148-55. DOI:10.1111/j.1752-7325.2009.00156.x · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine dental insurance transition dynamics in the context of changing employment and retirement status.
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.
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.
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.
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.
The American journal of managed care 10/2009; 15(10):729-35. · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS).
The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables.
The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate.
The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.
Journal of Public Health Dentistry 09/2009; 70(1):67-75. DOI:10.1111/j.1752-7325.2009.00145.x · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS).
We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables.
We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage.
Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.
Journal of Public Health Dentistry 09/2009; 70(1):1-12. DOI:10.1111/j.1752-7325.2009.00137.x · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: I examine the introduction of the Spouse's Allowance to the Canadian Income Security (IS) system. This program was nominally targeted at females in couples attempting to live on a single pension, allowing them to receive the age related benefits of the IS system at age 60, up to five years earlier than other members of the population. The results indicate that the introduction of the Allowance is associated with a six to seven percentage point relative decrease in labor force participation among males in eligible couples. Eligible females did not share the rising employment rates of their counterparts (of the same age) who were not eligible for the Allowance.
[Show abstract][Hide abstract] ABSTRACT: This report presents findings on the activities of the 103 organizations receiving Social Security Administration grants under the WIPA program, focusing on the period from April 1, 2010 through March 31, 2011. It counts the number of beneficiaries served by the WIPA program as a whole, documents the characteristics of beneficiaries served, and assesses the nature of the services and supports provided by the WIPA program to beneficiaries. It also relates costs and outputs for individual WIPA organizations.