Papers Containing Keywords(s): 'medicare'
The following papers contain search terms that you selected. From the papers listed below, you can navigate to the PDF, the profile page for that working paper, or see all the working papers written by an author. You can also explore tags, keywords, and authors that occur frequently within these papers.
See Working Papers by Tag(s), Keywords(s), Author(s), or Search Text
Click here to search again
Frequently Occurring Concepts within this Search
Authors
Alice Zawacki - 10
James Noon - 4
Viewing papers 1 through 10 of 27
-
Working PaperMeasuring Income of the Aged in Household Surveys: Evidence from Linked Administrative Records
June 2024
Working Paper Number:
CES-24-32
Research has shown that household survey estimates of retirement income (defined benefit pensions and defined contribution account withdrawals) suffer from substantial underreporting which biases downward measures of financial well-being among the aged. Using data from both the redesigned 2016 Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and the Health and Retirement Study (HRS), each matched with administrative records, we examine to what extent underreporting of retirement income affects key statistics such as reliance on Social Security benefits and poverty among the aged. We find that underreporting of retirement income is still prevalent in the CPS ASEC. While the HRS does a better job than the CPS ASEC in terms of capturing retirement income, it still falls considerably short compared to administrative records. Consequently, the relative importance of Social Security income remains overstated in household surveys'53 percent of elderly beneficiaries in the CPS ASEC and 49 percent in the HRS rely on Social Security for the majority of their incomes compared to 42 percent in the linked administrative data. The poverty rate for those aged 65 and over is also overstated'8.8 percent in the CPS ASEC and 7.4 percent in the HRS compared to 6.4 percent in the linked administrative data. Our results illustrate the effects of using alternative data sources in producing key statistics from the Social Security Administration's Income of the Aged publication.View Full Paper PDF
-
Working PaperThe Long-Term Effects of Income for At-Risk Infants: Evidence from Supplemental Security Income
March 2024
Working Paper Number:
CES-24-10
This paper examines whether a generous cash intervention early in life can "undo" some of the long-term disadvantage associated with poor health at birth. We use new linkages between several large-scale administrative datasets to examine the short-, medium-, and long-term effects of providing low-income families with low birthweight infants support through the Supplemental Security Income (SSI) program. This program uses a birthweight cutoff at 1200 grams to determine eligibility. We find that families of infants born just below this cutoff experience a large increase in cash benefits totaling about 27%of family income in the first three years of the infant's life. These cash benefits persist at lower amounts through age 10. Eligible infants also experience a small but statistically significant increase in Medicaid enrollment during childhood. We examine whether this support affects health care use and mortality in infancy, educational performance in high school, post-secondary school attendance and college degree attainment, and earnings, public assistance use, and mortality in young adulthood for all infants born in California to low-income families whose birthweight puts them near the cutoff. We also examine whether these payments had spillover effects onto the older siblings of these infants who may have also benefited from the increase in family resources. Despite the comprehensive nature of this early life intervention, we detect no improvements in any of the study outcomes, nor do we find improvements among the older siblings of these infants. These null effects persist across several subgroups and alternative model specifications, and, for some outcomes, our estimates are precise enough to rule out published estimates of the effect of early life cash transfers in other settings.View Full Paper PDF
-
Working PaperHow Do Health Insurance Costs Affect Firm Labor Composition and Technology Investment?
September 2023
Working Paper Number:
CES-23-47
Employer-sponsored health insurance is a significant component of labor costs. We examine the causal effect of health insurance premiums on firms' employment, both in terms of quantity and composition, and their technology investment decisions. To address endogeneity concerns, we instrument for insurance premiums using idiosyncratic variation in insurers' recent losses, which is plausibly exogenous to their customers who are employers. Using Census microdata, we show that following an increase in premiums, firms reduce employment. Relative to higher-income coworkers, lower-income workers see a larger increase in their likelihood of being separated from their jobs and becoming unemployed. Firms also invest more in information technology, potentially to substitute labor.View Full Paper PDF
-
Working PaperMethodology on Creating the U.S. Linked Retail Health Clinic (LiRHC) Database
March 2023
Working Paper Number:
CES-23-10
Retail health clinics (RHCs) are a relatively new type of health care setting and understanding the role they play as a source of ambulatory care in the United States is important. To better understand these settings, a joint project by the Census Bureau and National Center for Health Statistics used data science techniques to link together data on RHCs from Convenient Care Association, County Business Patterns Business Register, and National Plan and Provider Enumeration System to create the Linked RHC (LiRHC, pronounced 'lyric') database of locations throughout the United States during the years 2018 to 2020. The matching methodology used to perform this linkage is described, as well as the benchmarking, match statistics, and manual review and quality checks used to assess the resulting matched data. The large majority (81%) of matches received quality scores at or above 75/100, and most matches were linked in the first two (of eight) matching passes, indicating high confidence in the final linked dataset. The LiRHC database contained 2,000 RHCs and found that 97% of these clinics were in metropolitan statistical areas and 950 were in the South region of the United States. Through this collaborative effort, the Census Bureau and National Center for Health Statistics strive to understand how RHCs can potentially impact population health as well as the access and provision of health care services across the nation.View Full Paper PDF
-
Working PaperThe 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.View Full Paper PDF
-
Working PaperCovering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention
August 2022
Working Paper Number:
CES-22-28
Undocumented immigrants are ineligible for public insurance coverage for prenatal care in most states, despite their children representing a large fraction of births and having U.S. citizenship. In this paper, we examine a policy that expanded Medicaid pregnancy coverage to undocumented immigrants. Using a novel dataset that links California birth records to Census surveys, we identify siblings born to immigrant mothers before and after the policy. Implementing a mothers' fixed effects design, we find that the policy increased coverage for and use of prenatal care among pregnant immigrant women, and increased average gestation length and birth weight among their children.View Full Paper PDF
-
Working PaperDeveloping Content for the Management and Organizational Practices Survey-Hospitals (MOPS-HP)
September 2021
Working Paper Number:
CES-21-25
Nationally representative U.S. hospital data does not exist on management practices, which have been shown to be related to both clinical and financial performance using past data collected in the World Management Survey (WMS). This paper describes the U.S. Census Bureau's development of content for the Management and Organizational Practices Survey Hospitals (MOPS-HP) that is similar to data collected in the MOPS conducted for the manufacturing sector in 2010 and 2015 and the 2009 WMS. Findings from cognitive testing interviews with 18 chief nursing officers and 13 chief financial officers at 30 different hospitals across 7 states and the District of Columbia led to using industry-tested terminology, to confirming chief nursing officers as MOPS-HP respondents and their ability to provide recall data, and to eliminating questions that tested poorly. Hospital data collected in the MOPS-HP would be the first nationally representative data on management practices with queries on clinical key performance indicators, financial and hospital-wide patient care goals, addressing patient care problems, clinical team interactions and staffing, standardized clinical protocols, and incentives for medical record documentation. The MOPS-HP's purpose is not to collect COVID-19 pandemic information; however, data measuring hospital management practices prior to and during the COVID-19 pandemic are a byproduct of the survey's one-year recall period (2019 and 2020).View Full Paper PDF
-
Working PaperWho Values Human Capitalists' Human Capital? Healthcare Spending and Physician Earnings
July 2020
Working Paper Number:
CES-20-23
Is government guiding the invisible hand at the top of the labor market? We study this question among physicians, the most common occupation among the top one percent of income earners, and whose billings comprise one-fifth of healthcare spending. We use a novel linkage of population-wide tax records with the administrative registry of all physicians in the U.S. to study the characteristics of these high earnings, and the influence of government payments in particular. We find a major role for government on the margin, with half of direct changes to government reimbursement rates flowing directly into physicians' incomes. These policies move physicians' relative and absolute incomes more than any reasonable changes to marginal tax rates. At the same time, the overall level of physician earnings can largely be explained by labor market fundamentals of long work and training hours. Competing occupations also pay well and provide a natural lower bound for physician earnings. We conclude that government plays a major role in determining the value of physicians' human capital, but it is unrealistic to use this power to reduce healthcare spending substantially.View Full Paper PDF
-
Working PaperWhy are employer-sponsored health insurance premiums higher in the public sector than in the private sector?
February 2019
Working Paper Number:
CES-19-03
In this article, we examine the factors explaining differences in public and private sector health insurance premiums for enrollees with single coverage. We use data from the 2000 and 2014 Medical Expenditure Panel Survey-Insurance Component, along with decomposition methods, to explore the relative explanatory importance of plan features and benefit generosity, such as deductibles and other forms of cost sharing, basic employee characteristics (e.g., age, gender, and education), and unionization. While there was little difference in public and private sector premiums in 2000, by 2014, public premiums had exceeded private premiums by 14 to 19 percent. We find that differences in plan characteristics played a substantial role in explaining premium differences in 2014, but they were not the only, or even the most important, factor. Differences in worker age, gender, marital status, and educational attainment were also important factors, as was workforce unionization.View Full Paper PDF
-
Working PaperReporting 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.View Full Paper PDF
