The Short and Long Term Effects of Job and EArnings Losses on Health Outcomes

描述(由申请人提供)：正常的经济活动使工人的收入、就业和职业发展受到意想不到的冲击。例如，每年有超过10%的美国工人被解雇。尽管对许多工人来说，这些冲击可能是短暂的，但越来越多的文献表明，短期的职业冲击--例如非自愿失业--可能会对某些工人群体产生巨大而持久的影响。例如，成熟的失业工人往往会经历长期收入损失、就业机会减少、提前退休、工作不稳定增加，以及消费减少和医疗保险覆盖范围的损失。一篇长篇文献表明，收入、就业和健康之间存在着很强的相关性。此外，越来越多的文献将经济不确定性和不幸带来的压力与健康结果联系在一起。然而，目前还没有关于失业、经济结果以及短期和长期健康影响的全面研究，部分原因是缺乏关于大样本工人详细的纵向职业和健康信息的数据。这是公共政策特别关注的问题，因为许多失业者可能有资格享受残疾保险，大多数人最终也有资格享受联邦医疗保险。因此，失业成本的一个重要部分是由社会通过更高的医疗支出来承担。我们建议使用通过社会保障管理局通过持续合作获得的几个大型管理数据集来研究大规模裁员和公司关闭期间失业对短期和长期健康结果的影响。这些数据包含有关收入、残疾、死亡和医疗保险支出的信息，是实现这一目的的理想选择，因为它提供了1978年至2005年期间10%的美国人样本的收入和健康结果以及雇主的纵向信息。我们还使用收入和计划参与调查中提供的与健康相关的详细人口统计数据作为我们数据的一个子样本。这些数据使我们能够在公司层面隔离引发失业的事件，这些事件与工人以前的健康状况和收入没有关联。因此，我们可以隔离工人受到真正外部负面事件影响的情况，并跟踪失业后15到20年内对收入、参加残疾保险和死亡率的影响。当工人获得残疾保险或年满65岁时，我们还可以分析失业对医疗保险支出的影响。我们的研究设计使我们能够(1)评估大规模裁员或公司关闭期间失业对短期和长期健康结果和医疗支出的影响；(2)研究失业影响健康结果和医疗支出的渠道；以及(3)根据联邦医疗保险和社会保障残疾保险增加的支出，评估失业和收入分散的社会成本。为了回应审查者的意见，我们还使用调查数据来评估工人在失业前的健康状况，研究失业对健康的影响，而不是死亡率，并直接检查关键渠道，如是否有医疗保险或配偶收入。公共卫生相关性我们使用来自社会保障管理局的一个新的大型数据集，跨越25年的数据来研究大规模裁员或公司关闭期间失业对死亡率、发病率和长期医疗支出的影响。因此，我们可以更全面地了解个体工人失业的成本，以及通过增加联邦残疾保险和医疗保险的支出，社会承担的成本。

DESCRIPTION (provided by applicant): Regular economic activity exposes workers to unexpected shocks to their earnings, employment, and career development. For example, more than 10 percent of American workers are laid off every year. While for many workers these shocks may be short-lived, a growing literature shows that short-term career shocks - such as involuntary job losses - can have large and persistent effects for certain groups of workers. For example, mature displaced workers tend to experience long-term earnings losses, reduced employment probabilities, early retirement, increased job instability, as well as reductions in consumption and a loss in health insurance coverage. A long literature has demonstrated a strong correlation between earnings and employment and health. Moreover, a growing literature link stress from economic uncertainty and unhappiness to health outcomes. However, at present no comprehensive study of the effect of job loss, economic outcomes, and short and long-term health exists, partly due to a lack of data on detailed longitudinal career and health information for a large sample of workers. This is a particular concern for public policy, since many job losers may be eligible for disability insurance and most eventually become eligible for Medicare. Thus, an important part of the cost of job loss is borne by society through higher health expenditures. We propose to study the effects of job losses during mass-layoffs and firm closings on short and long term health outcomes using several large administrative data sets accessed through the Social Security Administration through an ongoing cooperation. The data contains information on earnings, disability, death, and Medicare expenditures and is ideal for this purpose, since it provides longitudinal information on earnings and health outcomes and employers for a 10 percent sample of Americans ranging from 1978 to 2005. We also use detailed health-related and demographic data from the Survey of Income and Program Participation available for a sub-sample of our data. The data allows us to isolate events at the firm level triggering job loss that are not correlated with workers' prior health status and earnings. Thereby, we can isolate situations in which workers are affected by truly external negative events, and follow the effect on earnings, entry into disability insurance, and mortality over 15 to 20 years after a job loss. As workers receive disability insurance or turn 65, we can also analyze the effect of job loss on Medicare expenditures. Our research design allows us to (1) evaluate the effects of job loss during mass-layoffs or firm closings on short- and long-term health outcomes and health expenditures; (2) to study the channels through which job loss affects health outcomes and health expenditures; and (3) to assess the social costs of job loss and earnings dispersion in terms of increased expenditures through Medicare and Social Security Disability Insurance. In response to reviewers' comments, we also use the survey data to assess workers' health prior to job loss, to study health effects of job loss other than mortality, and to directly examine key channels such as presence of health insurance or spousal income. PUBLIC HEALTH RELEVANCE We use a large new data set from the Social Security Administration spanning over 25 years of data to study the effects of job loss during mass-layoffs or firm closures on mortality, morbidity, and long-term health expenditures. Thereby, we obtain a more complete picture of the individual worker's costs of job loss, as well as of the costs society bears through increased expenditures for federal disability insurance and Medicare.