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

描述(由申请人提供)：在过去的几十年里，美国老年人的就业模式发生了巨大的变化，有两个重要的趋势。首先是上个世纪大部分时间主导的提前退休的趋势，但现在有逆转的迹象(Costa，1998)。第二是雇主-雇员关系的稳定性下降，表现为裁员增加，老年工人受到的影响不成比例(例如，Osterman 1999；Stevens 2001)。本项目的目的是就这些趋势对保健和保健利用的影响提供证据，分别侧重于自愿减少晚年就业的影响和非自愿中断晚年就业的影响。现有的经验性文献提供的关于这些影响的证据有限，有些相互矛盾。遗漏变量偏差的问题困扰着大多数分析，因为自愿或非自愿退出工作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。当前的应用程序使用挪威独特的基于人口的数据集来克服这些限制，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保健利用的影响；(2)估计因更早获得退休福利而导致的提前退休对老年工作者的健康和保健利用的影响。对于每一项分析，该项目将利用一种“自然实验”的方法来解决省略变量偏差的问题。为了研究非自愿工作中断的影响(目标1)，将比较在随后关闭的工厂中受雇的老年工人的结果，以及在稳定和成长中的工厂中类似工人的结果。为了研究自愿减少后世就业的影响(目标2)，这项分析利用了提前退休计划中的变化，这些变化导致有资格参加该计划的工人提前退休。利用差异差异框架，将符合条件的老年工作人员的保健和保健利用趋势(即变化前后)与不符合条件的老年工作人员的趋势进行比较，以得出可信的因果推论。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、就业场所特征、死亡结果以及与通过挪威医疗系统获得的所有住院和专家服务有关的医疗利用数据(包括日期和诊断)联系起来。虽然挪威数据的使用引发了对美国人口普适性的问题，但工作和就业中断影响健康的机制很可能是相似的，而且这些数据允许对医疗和医疗保健利用的影响进行更完整的核算，而不是使用现有的美国数据源。公共卫生相关性：最近退休行为和就业关系保障方面的变化可能对老年工人的健康和福祉以及为日益增长的老年人口的保健筹资产生重要影响。然而，非自愿工作中断(通过裁员)和自愿减少晚年就业(通过提前退休或推迟退休)对保健和保健利用的影响在很大程度上仍不清楚。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做出适当的政策反应，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。

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.