Demand for health services are examined among Americans ages 65 and older using the Medical Expenditure Panel Survey. Analyses are provided of mode of residence, demand for paid health services in private settings, and the choice of type of nursing home using a common set of explanatory variables. The research shows that age, Medicare coverage, and the use of assistive technology are the strongest predictors of mode of residence. The second analysis shows that total expenditures for paid home health care (HHC) and hospital care do not decrease as expected when the percentage paid by individuals and/or their families increases. Finally, the third analysis suggests that the distribution of nursing home (NH) services is related to ability to pay.
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Medicare Coverage and Reporting
December 2016
Working Paper Number:
carra-2016-12
Medicare coverage of the older population in the United States is widely recognized as being nearly universal. Recent statistics from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) indicate that 93 percent of individuals aged 65 and older were covered by Medicare in 2013. Those without Medicare include those who are not eligible for the public health program, though the CPS ASEC estimate may also be impacted by misreporting. Using linked data from the CPS ASEC and Medicare Enrollment Database (i.e., the Medicare administrative data), we estimate the extent to which individuals misreport their Medicare coverage. We focus on those who report having Medicare but are not enrolled (false positives) and those who do not report having Medicare but are enrolled (false negatives). We use regression analyses to evaluate factors associated with both types of misreporting including socioeconomic, demographic, and household characteristics. We then provide estimates of the implied Medicare-covered, insured, and uninsured older population, taking into account misreporting in the CPS ASEC. We find an undercount in the CPS ASEC estimates of the Medicare covered population of 4.5 percent. This misreporting is not random - characteristics associated with misreporting include citizenship status, year of entry, labor force participation, Medicare coverage of others in the household, disability status, and imputation of Medicare responses. When we adjust the CPS ASEC estimates to account for misreporting, Medicare coverage of the population aged 65 and older increases from 93.4 percent to 95.6 percent while the uninsured rate decreases from 1.4 percent to 1.3 percent.
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Income Packaging and Economic Disconnection: Do Sources of Support Differ from Other Low-Income Women?
December 2013
Working Paper Number:
CES-13-61
Income packaging, or piecing together cash and non-cash resources from a variety of sources, is a common financial survival strategy among low-income women. This strategy is particularly important for economically disconnected women, who lack both employment income and public cash assistance receipt. Using data from the confidential Census Bureau versions of the Survey of Income and Program Participation, this study compares the use of public and private supports between disconnected and connected low-income women, controlling for differences in state welfare rules and county unemployment rates. Findings from bivariate comparisons and multilevel logistic regressions indicate that disconnected women utilize public non-cash supports at similar rates to connected women, but rely more heavily on private sources. Conclusions focus on the policy implications for outreach and program development.
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Reporting of Indian Health Service Coverage in the American Community Survey
May 2018
Working Paper Number:
carra-2018-04
Response error in surveys affects the quality of data which are relied on for numerous research and policy purposes. We use linked survey and administrative records data to examine reporting of a particular item in the American Community Survey (ACS) - health coverage among American Indians and Alaska Natives (AIANs) through the Indian Health Service (IHS). We compare responses to the IHS portion of the 2014 ACS health insurance question to whether or not individuals are in the 2014 IHS Patient Registration data. We evaluate the extent to which individuals misreport their IHS coverage in the ACS as well as the characteristics associated with misreporting. We also assess whether the ACS estimates of AIANs with IHS coverage represent an undercount. Our results will be of interest to researchers who rely on survey responses in general and specifically the ACS health insurance question. Moreover, our analysis contributes to the literature on using administrative records to measure components of survey error.
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Health-Related Research Using Confidential U.S. Census Bureau Data
August 2008
Working Paper Number:
CES-08-21
Economic studies on health-related issues have the potential to benefit all Americans. The approaches for dealing with the growth of health care costs and health insurance coverage are ever changing and information is needed on their efficacy. Research on health-related topics has been conducted for about a decade at the Census Bureau\u2019s Center for Economic Studies and the Research Data Centers. This paper begins by describing the confidential business and demographic Census Bureau data products used in this research. The discussion continues with summaries of nearly 30 papers, including how this work has benefited the Census Bureau and its research findings. Some focus on data linkages and assessing data quality, while others address important questions in the employer, public, and individual insurance markets. This research could not have been accomplished with public-use data. The newly available data from the Agency for Healthcare Research and Quality and National Center for Health Statistics, as well as additional Census Bureau data now available in the Research Data Centers are also discussed.
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Manufacturing Firms' Decisions Regarding Retiree Health Insurance
June 2003
Working Paper Number:
CES-03-14
This study analyzes the firm's decision to offer and contribute to retiree health insurance. We apply a binomial probit model and an interval regression model to analyze the likelihood of offering and the proportion of costs contributed by the firm. Our findings indicate that while firm characteristics affect the probability that a firm offers retiree health insurance, financial performance and alternative insurance options significantly affect the firm's generosity towards its cost. This study expands on previous research by including potentially important policy-related measures to the more limited set of firm and workforce characteristics that have been typically employed.
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High Labor Force Attachment, but Few Social Ties? Life-Course Predictors of Women's Receipt of Childcare Subsidies
September 2019
Working Paper Number:
CES-19-26
The U.S. federal Child Care and Development Fund (CCDF) childcare subsidy represents the largest source of means-tested assistance for U.S. families with low incomes. The CCDF subsidy aims to help mothers with low incomes gain employment and education, with implications for women's labor force participation, and the wellbeing of their children. Because recipients of the CCDF subsidy are either already employed, or seek the subsidy with the goal of gaining employment or schooling, this group may represent the public assistance recipients who are best able to succeed in the low-wage labor market. However, existing research on the CCDF observes recipients only after they begin receiving the subsidy, thus giving an incomplete picture of whether recipients may select into subsidy receipt, and how subsidy recipiency is situated in women's broader work and family trajectories. My study links administrative records from the CCDF to the American Community Survey (ACS) to construct a longitudinal data set from 38 states that observes CCDF recipients in the 1-2 years before they first received the subsidy. I compare women who subsequently received the CCDF subsidy to other women with low incomes in the ACS who did not go on to receive the subsidy, with a total of roughly 641,000 individuals. I find that CCDF recipients are generally positively-selected on employment history and educational attainment, but appear to have lower levels of social support than non-recipients.
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Is Subsidized Childcare Associated with Lower Risk of Grade Retention for Low-Income Children? Evidence from Child Care and Development Fund Administrative Records Linked to the American Community Survey
June 2017
Working Paper Number:
carra-2017-06
This study investigates whether low-income young children's experience of Child Care and Development Fund (CCDF)-subsidized childcare is associated with a lower subsequent likelihood of being held back in grades K-12. High-quality childcare has been shown to improve low-income children's school readiness. However, no previous study has examined the link specifically between subsidized care and grade retention. I do so here by matching information on children from CCDF administrative records to later observations of the same children in the American Community Survey (ACS). I use logistic regression to compare the likelihood of grade retention between CCDF-recipient children and non-recipient children who also appear in the ACS in the years 2008-2014 (N=2,284,857). I find strong evidence for an association between CCDF-subsidized care and lower risk of grade retention, especially among non-Hispanic Black children and Hispanic children. I also find evidence that receiving CCDF-subsidized center-based care in particular is associated with a lower risk of being held back than CCDF-subsidized family daycare, babysitter care, or relative care, again with the largest apparent benefit to non-Hispanic Black children and Hispanic children.
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The Underserved Have Less Access to Employer-Sponsored Telemedicine Coverage
September 2022
Working Paper Number:
CES-22-40
Telemedicine has been proposed as one means of improving health care access for underserved communities, and information about insurance coverage for telemedicine (TMC) is important in understanding its utilization and provision. We use 2018-2019 Medical Expenditure Panel Survey-Insurance Component data on employer-sponsored coverage to examine pre-pandemic TMC relative to employer, worker, and health plan characteristics. We find that the share of employees in private sector establishments offering TMC was lower in the most rural counties, in smaller firms, in establishments without unionized employees, and in establishments where most workers were low wage, part-time and older when compared to other establishments. These findings reflect differences across establishments in insurance offers, as well as differences in TMC conditional on an insurance offer, which suggests that TMC may function as a premium plan feature with limited availability and potential support for improving healthcare access for the underserved.
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Contributions to Health Insurance Premiums: When Does the Employer Pay 100 Percent?
December 2005
Working Paper Number:
CES-05-27
We identify the characteristics of establishments that paid 100 percent of health insurance premiums and the policies they offered from 1997-2001, despite increased premium costs. Analyzing data from the MEPS-IC, we see little change in the percent of establishments that paid the full cost of premiums for employees. Most of these establishments were young, small, singleunits, with a relatively high paid workforce. Plans that were fully paid generally required referrals to see specialists, did not cover pre-existing conditions or outpatient prescriptions, and had the highest out-of-pocket expense limits. These plans also were more likely than plans not fully paid by employers to have had a fee-for-service or exclusive provider arrangement, had the highest premiums, and were less likely to be self-insured.
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Health Insurance and Productivity: Evidence from the Manufacturing Sector
September 2009
Working Paper Number:
CES-09-27
This paper examines the relationship between employer-sponsored offers of health insurance and establishments' labor productivity. Our empirical work is based on unique plant level data that links the 1997 and 2002 Medical Expenditure Panel Survey-Insurance Component with the 1992, 1997, and 2002 Census of Manufactures. These linked data provide information on employer-provided insurance and productivity. We find that health insurance offers are positively associated with levels of establishments' labor productivity. These findings hold for all manufacturers as well as those with fewer than 100 employees. Our preliminary results also show a drop in health care costs from the 75th to the 25th percentile would increase the probability of a plant offering insurance by 1.5-2.0 percent in both 1997 and 2002. The results from this paper provide encouraging and new empirical evidence on the benefits employers may reap by offering health insurance to workers.
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