Effect of Work and Employment Disruptions on Health and Health Care Utilization o

工作和就业中断对健康和医疗保健利用的影响

• 批准号: 7511870
• 负责人: Mark Edward Votruba
• 金额: $ 6.44万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7511870
• 关键词: Accounting; Address; Adult; Affect; Age; American; Behavior; Censuses; Characteristics; Closure; Conflict (Psychology); Data; Data Set; Data Sources; Diagnosis; Dimensions; Disruption; Economics; Elderly; Elderly man; Employee; Employment; Face; Future; Health; Health Status; Healthcare Systems; Hospitalization; Household; Income; Individual; Labor Forces; Life; Link; Literature; Marketing; Medical; Medicare; Natural experiment; Nature; Norway; Numbers; Occupations; Outcome; Outpatients; Pattern; Pensions; Persons; Plague; Plants; Policies; Population; Public Health; Purpose; Rate; Records; Relative (related person); Retirement; Risk; Security; Services; Social Security; Social Welfare; Specialist; Testing; Time; United States; Visit; Work; aged; base; career; cost; experience; falls; health care cost/financing; health care service utilization; hospital utilization; interest; labor force participation; mortality; programs; response; social; statistics; trend

DESCRIPTION (provided by applicant): Employment patterns of older persons in the United States have changed dramatically in the last several decades, marked by two important trends. The first is the trend towards earlier retirement that dominated much of the last century, but currently shows signs of reversing (Costa 1998). The second is the decreasing stability of employer-employee relationships, in the form of increased layoffs, to which older workers are disproportionately exposed (e.g. Osterman 1999; Stevens 2001). The purpose of this project is to provide evidence on the health and health care utilization implications of these trends, focusing separately on the effect of voluntary reductions in latter-life employment and the effect of involuntary disruptions in latter-life employment. The existing empirical literature provides limited and somewhat conflicting evidence regarding these effects. Problems of omitted variable bias plague most analyses, as older workers who exit employment, either voluntarily or involuntarily, are likely different from others across unobserved dimensions like health status. The current application uses a unique Norwegian population-based dataset to overcome these limitations and address the following aims: (1) to estimate the effects of involuntary work disruptions on the health and health care utilization of older workers; and (2) to estimate the effects of earlier retirement, induced through earlier availability of retirement benefits, on the health and health care utilization of older workers. For each analysis, the project will utilize a "natural experiment" approach to address problems of omitted variable bias. To study the effects of involuntary work disruptions (Aim 1), outcomes of older workers will be compared across workers employed in plants that subsequently closed and similar workers in stable and growing plants. To study the effects of voluntary reductions in latter-life employment (Aim 2), the analysis exploits changes in an early retirement program that induced earlier retirements among workers eligible for the program. Using a difference-in-differences framework, trends in the health and health care utilization of eligible older workers (i.e. before and after the change) will be compared to trends among ineligible older workers to draw credible causal inferences. The project will utilize an impressive array of longitudinal Norwegian data, linking individual and household characteristics, plant-of-employment characteristics, mortality outcomes, and health care utilization data (with dates and diagnoses) pertaining to all hospitalizations and specialist services obtained through the Norwegian health care system. While the use of Norwegian data raises issues of generalizability to the American population, the mechanisms through which work and employment disruptions affect health are likely to be similar, and the data allow for a more complete accounting of health and health care utilization effects than could be accomplished using existing U.S. data sources. PUBLIC HEALTH RELEVANCE: Recent changes in retirement behavior and in the security of employment relationships potentially have important implications for the health and wellbeing of older workers, as well as for the financing of health care for the growing population of older persons. However, the effects of involuntary work disruptions (through layoffs) and voluntary reductions in latter-life employment (through earlier versus later retirement) on health and health care utilization remain largely unknown. Credible causal estimates of these effects can help guide appropriate policy responses to these ongoing labor market trends, as well as inform policymakers of the health, welfare and fiscal implications of proposals to encourage latter-life employment.

描述（由申请人提供）：美国老年人的就业模式在过去几十年中发生了巨大变化，其特点是两个重要趋势。第一个是上个世纪大部分时间占主导地位的提前退休趋势，但目前有逆转的迹象（Costa 1998年）。第二个是雇主与雇员关系的稳定性下降，表现为裁员增加，老年工人不成比例地面临这种情况（例如，Osterman 1999; Stevens 2001）。该项目的目的是提供证据，这些趋势的健康和医疗保健利用的影响，分别侧重于晚年就业的自愿减少和晚年就业的非自愿中断的影响。现有的经验文献提供了有限的，有些矛盾的证据，这些影响。遗漏变量偏差的问题困扰着大多数分析，因为自愿或非自愿离职的老年工人在健康状况等未观察到的维度上可能与其他人不同。目前的应用程序使用一个独特的挪威人口为基础的数据集，以克服这些局限性，并解决以下目标：（1）估计非自愿工作中断对老年工人的健康和医疗保健利用的影响;（2）估计提前退休的影响，通过提前提供退休福利，对老年工人的健康和医疗保健利用。对于每一项分析，该项目将利用“自然实验”的方法来解决遗漏变量偏差的问题。为了研究非自愿工作中断的影响（目标1），将比较老年工人在随后关闭的工厂中雇用的工人和稳定和增长的工厂中雇用的类似工人的结果。为了研究自愿减少晚年就业（目标2）的影响，分析利用了提前退休计划的变化，导致符合该计划的工人提前退休。使用差异中的差异框架，将符合条件的老年工人的健康和医疗保健利用趋势（即改变之前和之后）与不符合条件的老年工人的趋势进行比较，以得出可信的因果推断。该项目将利用一系列令人印象深刻的挪威纵向数据，将个人和家庭特征、就业工厂特征、死亡率结果以及与通过挪威卫生保健系统获得的所有住院和专家服务有关的卫生保健利用数据（带有日期和诊断）联系起来。虽然挪威数据的使用引起了对美国人口的普遍性问题，但工作和就业中断影响健康的机制可能是相似的，并且这些数据可以比使用现有的美国数据源更完整地说明健康和医疗保健利用的影响。 公共卫生关系：最近退休行为和就业关系安全方面的变化可能对老年工人的健康和福祉以及日益增多的老年人的保健筹资产生重要影响。然而，非自愿的工作中断（通过裁员）和自愿减少晚年就业（通过提前退休和推迟退休）对健康和医疗保健利用的影响在很大程度上仍然是未知的。对这些影响的可信因果估计有助于指导对这些持续的劳动力市场趋势的适当政策反应，并向政策制定者通报鼓励晚年就业的建议对健康、福利和财政的影响。