بیمه درمانی و رفتار دوران بازنشستگی: شواهد حاصل از بررسی های بهداشتی و بازنشستگی

This paper studies the role of health insurance in the retirement decisions of older workers. As policymakers consider mechanisms for how to increase access to affordable health insurance for the near elderly, considerations of the potential labor force implications of such policies will be important to consider — potentially inducing retirements just at a time when the labor force is shrinking. Using data from the 1992 and 1996 waves of the Health and Retirement Survey, this study demonstrates that access to post-retirement health insurance has a large effect on retirement. Among older male workers, those with retiree health benefit offers are 68% more likely to retire (and those with non-employment based insurance are 44% more likely to retire) than their counterparts who would lose employment-based health insurance upon retirement. In addition, the study demonstrated that in retirement models, when retiree health benefits are controlled for, the effects of pension coverage are reduced, suggesting that these effects may have been overestimated in the prior literature

With the aging of the baby boom generation, the number of near elderly Americans will rise dramatically in coming years. By 2020, it is estimated that there will be twice as many near elderly Americans as today. This is a population group for whom access to affordable health insurance can be problematic, particularly if the employment relation is severed. Employers are the primary source of health insurance for Americans aged 55 to 64. Recently, however, there has been a strong downward trend in the generosity of retiree health benefit offers by employers. Yet few other routes to insurance exist for persons in this age group. Unless blind or disabled, persons under age 65 cannot qualify for Medicare or Medicaid. Options for purchase of health insurance in the private individual markets are equally restricted. Due to insurance underwriting practices, preexisting conditions may be excluded, and some persons in poor health are not insurable at all. For those who are insurable, premium costs in individual markets may be prohibitively high. While continuation and portability mandates (under COBRA and HIPAA) provide for continuing health insurance after leaving an employer, the premiums for this insurance can also be very high for older Americans. Yet, the near elderly are a vulnerable population group. Because the prevalence of poor health and chronic disease rises with age, they have higher expected medical expenses than younger cohorts. For instance, average health care expenditures for persons aged 55–64 are US$5000 compared to US$2200 for persons aged 35–44 (General Accounting Office, 1998). These concerns have led policymakers to consider various options for increasing access to affordable health insurance for near elderly Americans. These include such recent proposals as allowing persons aged 62 and older to buy into Medicare, and for displaced workers to buy in as early as age 55. One of the most common criticisms of such proposals are the potential adverse labor force outcomes associated with access to post-retirement health insurance — potentially inducing early retirement just at a time when the labor force will already be shrinking due to the retirement of the baby boom generation. An understanding of the retirement effects associated with health insurance access and cost will be critical to understanding the effects on the labor market of public policies aimed at increasing access to affordable health insurance among the near elderly.

With the leading edge of the baby boom generation now turning 50, the number of near elderly persons will rise dramatically in coming years. By 2010 there will be almost as many Americans aged 55–64 as those aged 65 and older. Yet, while persons over age 65 have access to health insurance through Medicare, the near elderly have very limited options for affordable health insurance other than employers. Due to the increasing prevalence of poor health and chronic conditions with age, this is a population group with high expected medical expenditures. A number of policy initiatives have been aimed at increasing access to health insurance for the near elderly, such as proposals to allow persons younger than age 65 to buy into Medicare. However, these initiatives have been criticized for their potential labor force effects, inducing retirement just at a time when the labor force is shrinking. The results of this study demonstrate that offers of post-retirement health insurance are associated with an increased propensity to retire early, estimated to be 68% of the baseline probability. This is likely to be an upper bound, however, on the effect of access to employer-sponsored health insurance in retirement due to potential selection effects among older workers. However, the level of premium cost sharing in retirement relative to while working does not appear to influence the retirement decisions of older workers. The importance of health insurance is also highlighted by the job lock among workers who would lose their health benefits if they retired compared to those who have health insurance from non-employment based sources. Workers who have either public or private insurance are much more likely to retire (a 44% increase in the baseline) than their counterparts who have health insurance from their employers but do not have retiree health insurance. In contrast, however, persons who are uninsured also appear to be job locked. This may be due to the need to continue to work in order to protect against the costs of being uninsured. Ultimately, policymakers will need to balance the benefits of increased access to health insurance against the labor force effects associated with such policies.