Bradley Cathy J, Neumark David, Motika Meryl
Department of Healthcare Policy and Research, Massey Cancer Center, Virginia Commonwealth University, Richmond, USA.
Int J Health Care Finance Econ. 2012 Dec;12(4):253-67. doi: 10.1007/s10754-012-9113-2. Epub 2012 Sep 15.
Employment-contingent health insurance (ECHI) has been criticized for tying insurance to continued employment. Our research sheds light on two central issues regarding employment-contingent health insurance: whether such insurance "locks" people who experience a health shock into remaining at work; and whether it puts people at risk for insurance loss upon the onset of illness, because health shocks pose challenges to continued employment. We study how men's dependence on their own employer for health insurance affects labor supply responses and health insurance coverage following a health shock. We use the Health and Retirement Study (HRS) surveys from 1996 through 2008 to observe employment and health insurance status at interviews 2 years apart, and whether a health shock occurred in the intervening period between the interviews. All employed married men with health insurance either through their own employer or their spouse's employer, interviewed in at least two consecutive HRS waves with non-missing data on employment, insurance, health, demographic, and other variables, and under age 64 at the second interview are included in the study sample. We then limited the sample to men who were initially healthy. Our analytical sample consisted of 1,582 men of whom 1,379 had ECHI at the first interview, while 203 were covered by their spouse's employer. Hospitalization affected 209 men with ECHI and 36 men with spouse insurance. A new disease diagnosis was reported by 103 men with ECHI and 22 men with other insurance. There were 171 men with ECHI and 25 men with spouse employer insurance who had a self-reported health decline. Labor supply response differences associated with ECHI-with men with health shocks and ECHI more likely to continue working-appear to be driven by specific types of health shocks associated with future higher health care costs but not with immediate increases in morbidity that limit continued employment. Men with ECHI who have a self-reported health decline are significantly more likely to lose health insurance than men with insurance through a spouse. With the passage of health care reform, the tendency of men with ECHI as opposed to other sources of insurance to remain employed following a health shock may be diminished, along with the likelihood of losing health insurance.
就业关联型健康保险(ECHI)因将保险与持续就业挂钩而受到批评。我们的研究揭示了与就业关联型健康保险相关的两个核心问题:这种保险是否会使经历健康冲击的人“锁定”在工作岗位上;以及它是否会使人们在患病时面临失去保险的风险,因为健康冲击对持续就业构成了挑战。我们研究男性对自身雇主提供的健康保险的依赖如何影响健康冲击后的劳动力供给反应和健康保险覆盖情况。我们使用1996年至2008年的健康与退休研究(HRS)调查,以观察相隔两年的访谈中的就业和健康保险状况,以及在两次访谈之间的间隔期是否发生了健康冲击。所有通过自身雇主或配偶雇主获得健康保险的在职已婚男性,在至少连续两次HRS调查中接受访谈,且就业、保险、健康、人口统计及其他变量数据无缺失,第二次访谈时年龄在64岁以下,均被纳入研究样本。然后我们将样本限制为最初健康的男性。我们的分析样本包括1582名男性,其中1379名在第一次访谈时有就业关联型健康保险,203名由其配偶的雇主提供保险。住院影响了209名有就业关联型健康保险的男性和36名有配偶保险的男性。103名有就业关联型健康保险的男性和22名有其他保险的男性报告了新的疾病诊断。有171名有就业关联型健康保险的男性和25名由配偶雇主提供保险的男性自我报告健康状况下降。与就业关联型健康保险相关的劳动力供给反应差异——经历健康冲击且有就业关联型健康保险的男性更有可能继续工作——似乎是由与未来更高医疗成本相关的特定类型的健康冲击驱动的,而不是由限制持续就业的发病率立即上升驱动的。自我报告健康状况下降的有就业关联型健康保险的男性比通过配偶获得保险的男性失去健康保险的可能性显著更高。随着医疗改革的推进,与其他保险来源相比,有就业关联型健康保险的男性在健康冲击后继续就业的倾向以及失去健康保险的可能性可能会降低。