Using the Medicare buy-in program to estimate the effect of Medicaid on SSI participation

This article assesses the importance of receiving supplemental health insurance on participation in Supplemental Security Income (SSI) for the elderly. The implementation of the Qualified Medicare Beneficiary (QMB) program offered a substitute for Medicaid, and expanded health insurance eligibility to a higher income level. Using a sample of elderly respondents aged 66 to 75, I find that the QMB program reduced SSI participation. More than half of the QMB participants were previously covered by SSI and Medicaid. The calculations suggest that the QMB program was not as expensive as it might first appear because of reductions in SSI expenditure.     

农村居民养老保险财政补贴的福利效应研究

财政补贴是农村居民养老保险制度的核心,是农村居民养老保险制度推行和发展的关键。本研究从保障农民基本生活、调节收入分配、促进农村消费和激励农民参保缴费等4个维度对农村居民养老保险财政补贴的福利效应进行分析,发现当前补贴政策存在保障水平不高,地区分配不均,可持续性不强,激励约束不到位等问题。认为通过加大财政补贴支持力度,明确养老待遇调整机制,改善基金运营监管,调整参保缴费激励方案等多重措施,可以更好地发挥农村养老保险制度的福利效应,实现制度从规模扩张向高质量发展的转变。     

Adherence to exercise programs and determinants of maintenance in older adults with mild cognitive impairment

After a randomized controlled trial showing that improvement on some aspects of cognitive function was related to adherence to an exercise program, determinants of adherence and maintenance were further studied. Older adults with mild cognitive impairment were contacted 6 mo after the end of exercise programs for a telephone interview addressing patterns of adherence and determinants of maintenance. Mean adherence during the trial was 53%. About one third of participants had lapses during the trial but completed, one third had no lapses, and one third dropped out or never started. Practical barriers (time, location) were related to not starting and functional limitations to dropout. After the trial 25% of participants continued the programs, 14% reported intention to continue, and 61% quit. Maintenance was determined by fewer health complaints, higher satisfaction with the programs, and better adherence during the programs. Although maintenance was low, this study identified several reasons and barriers to adherence and maintenance that could be addressed.     

Distress,Need for Help,and Positive Feelings Derived from Participation in Sex Research: Findings of a Population Study in the Netherlands

To inform cost-benefit analyses of potential harms and benefits for participants in sex research, the current study investigated potential effects of completing a self-report sex survey. The data stem from a sexual health study in a population sample in the Netherlands (N = 8,064; 15 to 70 years old). Three measures assessed potential effects of participation: distress, need for help, and positive feelings related to research participation. Analyses showed that levels of experienced distress and need for help resulting from participation in a self-report sex survey were low, while participants reported positive feelings to a considerable extent. Only few participants reported levels of positive experiences that were lower than the levels of distress (4.8%) or need for help (1.7%) they experienced. Although differences were found according to sociodemographic characteristics and sexual experiences, the proportion of variance explained by these variables was generally small. While the findings of this study show that the balance between potential harm and positive outcomes seems disturbed for few participants, researchers should provide participants with the details of care providers in case they experience any distress or need for help.     

HEALTH CARE, INSURANCE, AND THE CONTRACT CHOICE EFFECT

This article explores the interdependence between the individual consumer's demand for medical care and choice of health insurance coverage, with emphasis on its implications for demand behavior and empirical analysis. We show that an increase in the price of medical care has two effects on demand, the usual response of reduced quantity demanded and a health insurance contract choice effect resulting from the consumer's incentive to change insurance plan. The contract choice effect, widely neglected in studies of medical care demand, alters both the quantitative and qualitative predictive properties of the consumer's demand for medical services. (JEL D11, D81, I11 )     

Determinants of female labor force participation: A study of Seoul,South Korea, 1970–1980

This paper investigates the determinants of labor force participation of women living in male-headed households in Seoul, South Korea, at two points in time, 1970 and 1980. Analysis of data from the 1970 and 1980 Korean Population Censuses suggests that both women's educational level and the family economic status determine women's labor force participation in Seoul. Women with middle school education or above are more economically active than those with no education. Women from lower economic backgrounds are almost two to three times more likely to be employed than those in high-status families, controlling for age, number of children under 6, and marital status. However, this pattern is not found among women from the blue-collar wage-working families.An earlier version of this paper was presented at the 1988 meetings of the Population Association of America.     

ENTITLEMENT EFFECTS, UNEMPLOYMENT INSURANCE AND EMPLOYMENT DECISIONS

Many studies have identified the work disincentive effects of unemployment insurance. This paper points out the entitlement effect of this and other social insurance programs on employment, as the risks of labor-market participation are reduced by the existence of unemployment benefits. This employment-increasing effect can offset the disincentive effect, with the net impact on employment becoming an empirical issue. Using data on a sample of married women for 1971, we find that on net there is a slight negative effect on employment of higher unemployment insurance benefits. The entitlement effect on employment is, though, generally positive and significant, suggesting that the provisions of social insurance induce increased labor-force participation among women who otherwise would remain out of the labor force.     

The relationship between the community participation of disabled youth and socioeconomic factors: mixed-methods approach in rural Sri Lanka

Mixed methods were applied to examine the association of community participation by disabled youth with socioeconomic factors in rural Sri Lanka. There was a significant association between community participation and socioeconomic factors in the quantitative survey (n = 116): participants living in socioeconomically disadvantaged conditions had lower levels of community participation than those living without these disadvantages. Consistent with the findings of the survey, previous educational experiences, household economic conditions, and perceived resource information were common themes in the qualitative study (n = 26). The dynamics of these factors, including marginalisation of disabled youth within the household, were also observed.     

Income Volatility and Family Structure Patterns: Association with Stability and Change in Food Stamp Program Participation

Using the Fragile Families and Child Well-Being Study, this research investigated how income volatility and family structure patterns influence participation patterns of stability and change in Food Stamp Program participation among a sample of young families (n = 1,263). Multinomial logistic regression models suggested that families that experienced significant declines in income were more likely to persistently participate and initiate participation than to never participate. Furthermore, stably married families were more likely to never participate; while other stable family structures (cohabitating couples and singles) and transitional unions were associated with persistent participation compared to other participation patterns. Immigration status, health, multiple indicators of economic hardship, and participant access rates were also significant in predicting patterns of participation. Strategies to increase participation are discussed.     

CHARITIES, NO; LOTTERIES, NO; CASH, YES: MAIN EFFECTS AND INTERACTIONS IN A CANADIAN INCENTIVES EXPERIMENT

The effects on response rates to mail surveys of prepaymentcash incentives, charitable donations, and the chance to wina lottery prize are examined in a true experimental design.A survey on environmental issues was conducted during the fallof 1994 among 3,088 households drawn from the Grand River watershedregion of southwestern Ontario, Canada. The 20-cell incentivesexperiment crossed three levels of prepaid monetary cash incentive($2, $5, and $10) with a control group (no cash incentive),plus the offer to make a charitable donation ranging from $2to $10 on behalf of the respondent, or participation in a lotteryfor prizes of $200. The overall response rate to the survey,with three follow-ups, was 70.7 percent with the effects ofthe prepaid cash rewards demonstrated, but not those for thelottery or charitable donations. Logistic regression analysisof response rate supports a main effects model for cash incentivesbut does not support either of two alternative models for maineffects of the lottery and charitable donations or interactions.Further analysis demonstrates a pattern of earlier responseas a result of prepaid incentives. The findings are discussedin terms of their cost-benefit implications and with respectto conceptualizations of respondents' motives for completingmail questionnaires.     

INVOLUNTARY, EMPLOYMENT IN CONTRACTS WITH RISKY JOB SEARCH

The implication of partially insurable job search risk for incentive compatibility in a standard contracting framework are explored. When unemployment spells provoke job search, workers face risk in spell duration and reemployment wages. When search effort is not variable, contracts including unemployment insurance will yield involuntary employment. When search effort is diminished by UI benefits, firms shift some compensation back to wages, increasing the relative attractiveness of employment. The analysis begins with a theorem on incomplete insurance by Imai, Geanakoplos and Ito [1981] for which a simple proof and economic intuition are provided.     

Parents' Marital Status, Conflict, and Role Modeling: Links With Adult Romantic Relationship Quality

This study investigated three parental marital statuses and relationship quality among unmarried, but dating adults ages 18 to 35 (N = 1153). Those whose parents never married one another tended to report the lowest relationship quality (in terms of relationship adjustment, negative communication, commitment, and physical aggression) compared to those with divorced or married biological parents. In addition, those with divorced parents reported lower relationship adjustment and more negative communication than those with married parents. Parental conflict and the degree to which participants rated their parents' relationship as a healthy model for their own relationships partially explained the associations between parental marital status and relationship outcomes. We suggest that this particular family type (i.e., having parents who never marry one another) needs greater attention in this field in terms of research and intervention.     

Effects of incentive size and timing on response rates to a follow-up wave of a longitudinal mailed survey

Young adults who had previously participated in a longitudinal survey of youth were sent a questionnaire. They were randomly assigned to receive a $20 prepayment, a $20 postpayment, or a $25 postpayment for participation in the latest survey. Those in the large incentive condition were 7 percentage points more likely to return a survey than those in the smaller, postpayment group. Prepayment had a smaller, less reliable effect. Effects of incentive magnitude and timing were consistent at each month of the study period; only better high school grades distinguished early responders from late responders. Nonresponders had characteristics suggestive of low social conformity and were more likely than responders to be African American and male and have low SES. The discussion centers on motivations for participating in research and differences in the incentives likely to promote continued response versus initial study enrollment.     

Fertility, labor force participation, and tastes: An economic psychology perspective

Economic and economic psychology models of wife's labor force participation and family size decisions are examined within the context of a marriage cohort. Among other results, it was found that tastes influence the demand for work and number of children, along with traditional economic determinants such as opportunity costs and income. Tastes have an especially strong impact when modeled as unobservables, in order to correct for measurement error. Further, the often observed empirical association between labor force participation and fertility is found to be spurious and not necessarily causal in nature. That is, labor force participation and fertility negatively covary largely as a consequence of common economic and taste antecedents and not due to reciprocal interactions. Hypotheses were tested using a new structural equation methodology.     

Retirement plan participation and features and standard of living of Americans 55 or older

This Issue Brief is the third in a series of Employee Benefit Research Institute (EBRI) publications based on data collected in 1998 and released in 2002 as the Retirement and Pension Plan Coverage Topical Module of the 1996 Survey of Income and Program Participation (SIPP). This report completes the series by examining the survey's more detailed questions concerning workers' employment-based retirement plans. Specifically, it examines the percentage of workers who are participating in a plan, and also workers' reasons for not participating in a plan when working in a job where a plan is sponsored; the features of, or decisions made concerning salary reduction plans; historical participation in employment-based retirement plans; and a comparison of the standard of living of individuals age 55 or older with their living standard in their early 50s. As of June 1998, 64.3 percent of wage and salary workers age 16 or older worked for an employer or union that sponsored any type of retirement plan (defined contribution or defined benefit) for any of its employees or members (the "sponsorship rate"). Almost 47 percent of these wage and salary workers participated in a plan (the "participation rate"), with 43.2 percent being entitled to a benefit or eligible to receive a lump-sum distribution from a plan if their job terminated at the time of survey (the "vested rate"). The predominant reason for choosing not to participate in a retirement plan was that doing so was unaffordable. The eligible participation rate for salary reduction plans was 81.4 percent. Fifty-six percent of all workers have participated in some type of retirement plan sometime during their work life through 1998. For those ages 51-60, almost 72 percent have ever participated in a plan. The median account balance in salary reduction plans in 1998 was $14,000. In 1998, 12.9 percent of salary reduction plan participants eligible to take a loan had done so, and the average outstanding loan balance was $5,196. Nearly 80 percent of those age 55 or older reported that their standard of living is about the same or better now than it was when they were in their early 50s. The incidence of both pension income and health insurance from a former employer had a significant impact on retirees' ability to maintain their standard of living. In addition, those who spent their entire most recent lump-sum distribution were more likely to have a much worse standard of living in retirement than those who rolled over their entire most recent distribution.     

"You feel like people are looking at you and laughing": Older adults' perceptions of aquatic physical activity

Older adults' participation in Physical Activity (PA) in the United Kingdom remains low. Moreover, although the subjective and narrative elements of aging are increasingly studied, promotion of healthy behaviours such as aquatic PA still frequently reduces older adults to passive recipients who rely on health professionals for their wellbeing. Using a figurational perspective, the relationship between participants' perceptions of the aging body and participation in aquatic activity was investigated. Interviews were completed with 22 adults aged over 50years (7 men, 15 women). Participants highlighted a number of perceptual barriers that were contoured by wider social representations of older adults. Perceptions focussed upon the perceived limitations of the aging body. The need for regular participation in PA was recognised. However the potential for angst when wearing a bathing costume in the presence of 'others' was expressed, particularly amongst those considering themselves overweight. Participants objectified their bodies and compared them with those of other participants. The difficulties of managing physical (e.g. injury and illness) and environmental risk were described. At the same time, participants experienced the development of new webs of interdependence. These webs were both enabling and constraining. Some participants felt empowered. However, the exclusivity of many aquatic activity sessions re-emphasised the status of older adults as outsiders in the wider figuration of physical activity.     

Street Fighters with Insurance Coverage: The Insurance System of the Nazi Storm Section (Sturmabteilung)

The Storm Section (Sturmabteilung, or SA) was organized throughout the Weimar Republic as a paramilitary force entrusted with the ‘fight for the streets’ during the so-called ‘time of struggle’ (Kampfzeit). To offset the potentially paralyzing effects of activism entailing risks of injury or death, the leaders of the movement devised and implemented an insurance system, which was retained throughout the following years. This insurance system smoothed the way for the most radical uncivility to hold sway without restriction during the final years of the Republic. Starting from late 1926, the National Socialist mechanism for overcoming the barriers to participation in violent activities that could potentially involve a high cost was to introduce an insurance system to facilitate their activists' willingness to ‘sacrifice’ themselves. The visceral anti-Semitism of the Nazis was central to the negotiations and agreements reached with different insurers. The Nazis introduced an insurance policy for their activists that would cover them while carrying out their obligations as militants in the ‘fight’ against Social Democrats and, more often, Communists. By lowering the potential costs of participation in a high-risk instance of activism, the insurance system contributed to stoking a ‘latent civil war’ in the German streets during the final years of the Republic. Relaying on archival and other primary sources and looking at them from a collective action perspective, this paper delves into the history of the SA insurance system, as well as on its functions.     

Effects and Costs of Tracing Strategies on Nonresponse Bias in a Survey of Workers with Low-Back Injury

Declining rates of participation are an increasing challengefor studies that involve telephone surveys. This study examinedthe costs of a telephone survey methodology that used increasinglyintensive tracing methods to track a pool of claimants who hadsustained occupational back injuries. It also compared the respondentsample to people who refused the survey and/or were not locatedor contacted. 3,181 claimants were drawn from a database maintainedby the Missouri Division of Workers’ Compensation (DWC)and 1,475 completed a telephone interview. The DWC databaseprovided data reflecting monetary and disability outcomes forall potential participants; telephone interviews provided additionalself-reported data. More intensive tracing strategies improvedthe representativeness of the sample, yielding more women andminority participants. Relative to less intensive techniques,advanced tracing efforts located people whose DWC records weremore similar to claimants not located. While the hands-on tracingefforts reduced the apparent bias of the respondent sample,costs increased as tracing strategies intensified – over$98,000 was spent to trace 1,027 claimants who were never locatedor contacted. The results suggest some guidelines that may facilitatedecision-making for researchers and funders who must balancethe trade-off between costs and nonresponse bias when planningsurveys.     

Voluntary long-term care insurance: best practices for increasing employee participation

This is the second of two Issue Briefs (April and May 2000) on long-term care (LTC) insurance. The previous Issue Brief addressed the problem of increasing sponsorship, while this report addresses the issue of increasing employee participation. Participation rates in group LTC insurance plans tend to be low. A potential watershed event for the development of the employment-based group LTC market is the proposed LTC program for federal employees and retirees (a program that would have to be enacted by Congress). The perception of a successful offering to federal employees could provide an enormous boost to the group LTC insurance market. Employee communication and education are seen as critical to the success of LTC enrollments. The importance of support shown by an employer for a new LTC plan offering cannot be overstated. Unlike 401(k) plan participation trends, LTC participation rates are highest among large companies. Insurers tend to view the 40-60 age range as the primary target for group LTC insurance, and employee salary as the best predictor of LTC insurance enrollment. Higher educational levels also are associated with higher levels of LTC participation. Perceived need for LTC insurance is perhaps the biggest barrier to the purchase of LTC insurance by employees due to competing financial priorities and the fact that LTC issues are generally off the "radar screens" of younger employees. Plans with skilled nursing home and home care benefits experience higher participation rates than plans lacking these benefits. The availability of lower-cost and long duration benefit options can be an important factor in determining participation. Most sponsors have chosen to offer noncontributory (i.e., fully employee-paid) LTC plans. Employer reluctance to make contributions may be caused by HIPAA's prohibition on the inclusion of LTC insurance in cafeteria plans. One of the major advantages of group LTC plans is the availability of guaranteed issue (i.e., issuing coverage without requiring evidence of insurability) for employees, which is not available in the individual LTC market. It is easy for enrollment to be derailed by the presence of any of a number of harmful conditions, such as employer-sponsors who distance themselves from the offer, ineffective communications, or difficult enrollment processes. Achieving consistently strong levels of participation in LTC plans will require employer-sponsors and their insurance carriers to form strong partnerships, with worker participation as their primary stated goal.