Health Insurance, Labor Supply, and Health

描述(由申请人提供)：我们建议的研究使用准实验设计来估计治疗依从性、健康结果和劳动力供应如何响应个人的保险是否由其自己的雇主提供。由于许多女性通过配偶的就业获得医疗保险，而其他许多女性通过自己的就业获得医疗保险，因此女性对疾病的劳动力供应反应--以及这种反应如何取决于医疗保险的来源--为解决我们的研究问题提供了一个自然的背景。因此，我们选择了新诊断为乳腺癌的已婚在职妇女及其配偶作为研究对象，调查ECHI、健康和劳动力供应之间的关系。我们的目标是：1)比较参加就业性医疗保险的女性和通过配偶参加医疗保险的女性之间的治疗和治疗依从性。我们之前的研究提供的证据表明，患有ECHI的女性可能会放弃治疗(如放射剂量、化疗疗程)，以避免其满足工作需求的能力受到干扰。为了正式调查这一点，我们建议从医疗记录中提取治疗和治疗依从性数据。然后，我们将根据医疗保险的来源来审查治疗和治疗依从性之间的关系。治疗和治疗依从性可能预示着癌症复发和死亡率等长期健康结果。2)比较参加就业性健康保险的妇女和通过配偶参加健康保险的妇女的健康状况变化。我们研究的最重要方面之一是ECHI等政策最终如何影响健康状况。我们将在确诊后2个月、6个月和12个月通过获取妇女对问卷(特别是SF-36和癌症治疗-乳房功能评估(FACT-B))的回答来检查健康状况。3)比较参加就业型医疗保险的女性和通过配偶参加医疗保险的女性对癌症的劳动力供应反应。我们建议收集数据，以比较乳腺癌对确诊后2个月、6个月和12个月的在职已婚妇女劳动力供应的影响，相对于她们确诊前的劳动力供应。4)检查配偶在被诊断为乳腺癌后的劳动力供应反应。可以想象，ECHI为患有乳腺癌的女性的有工作的、健康的配偶创造了类似的劳动力供应激励，就像它对患有这种疾病的女性所做的那样。患有ECHI的配偶可能会保持较高的劳动力供应，因此放弃护理活动，以便他们能够保留他们的ECHI。据我们所知，这一解决ECHI激励和陷阱的综合方法以前从未被研究过。

DESCRIPTION (provided by applicant): Our proposed research uses a quasi-experimental design to estimate how treatment adherence, health outcomes, and labor supply respond to whether or not an individual's insurance is provided by their own employer. Because many women obtain health insurance through their spouse's employment, while many others obtain it through their own employment, the labor supply response of women to illness-and how that response depends on the source of the health insurance-provides a natural context for addressing our research questions. Thus, we chose employed, married women newly diagnosed with breast cancer and their spouses as subjects for an investigation into the relationship between ECHI, health, and labor supply. Our aims are: 1) To compare treatment and treatment adherence between women with employment- contingent health insurance and women with health insurance through their spouse. Suggestive evidence from our prior study indicated that women with ECHI may forego treatment (e.g., doses of radiation, courses of chemotherapy) to avoid interruptions in their ability to meet work demands. To formally investigate this, we propose to abstract treatment and treatment adherence data from medical records. We will then examine the relationship between treatment and treatment adherence based on source of health insurance. Treatment and treatment adherence may be indicative of long-term health outcomes such as cancer recurrence and mortality. 2) To compare changes in health status between women with employment- contingent health insurance and women with health insurance through their spouse. One of the most important aspects of our research is how policies such as ECHI ultimately affect health status. We will examine health status by obtaining women's responses to questionnaires (specifically, the SF-36 and the Functional Assessment of Cancer Therapy-Breast (FACT-B)) at 2, 6, and 12 months following diagnosis. 3) To compare labor supply responses to cancer between women with employment-contingent health insurance and women with health insurance through their spouse. We propose to collect data with which to compare the effects of breast cancer on the labor supply of employed married women 2, 6, and 12 months following diagnosis, relative to their labor supply at the time immediately preceding their diagnosis. 4) To examine the labor supply responses of spouses following their partner's breast cancer diagnosis. Conceivably, ECHI creates similar labor supply incentives for employed, healthy spouses of women with breast cancer as it does for women with the disease. Spouses with ECHI may maintain high labor supply and hence forego care giving activities so that they can preserve their ECHI. To our knowledge, this integral way of addressing the incentives and pitfalls of ECHI has not been previously examined.