• Selected
• Entire List

Abstract:
Major events in the life of an elderly individual, such as retirement, a significant decrease in income, death of the spouse, disability, and a move to a nursing home, may affect the mental health status of the individual. For example, the individual may enter a prolonged depression. We investigate this using unique longitudinal panel data that track labour market behaviour, health status, and major life events, over time. To deal with endogenous aspects of these events we apply fixed effects estimation methods. We find some strikingly large effects of certain events on the occurrence of depression. We show that the results are of importance for the design of health care and labour market policy towards the elderly.

Death, retirement, income loss, disease, depression, health indicators, widowhood, care, panel data, endogeneity, fixed effects

Abstract:
Major events in the life of an elderly individual, such as retirement, a significant decrease in income, death of the spouse, disability, and a move to a nursing home, may affect the mental health status of the individual. For example, the individual may enter a prolonged depression. We investigate this using unique longitudinal panel data that track labor market behavior, health status, and major life events, over time. To deal with endogenous aspects of these events we apply fixed effects estimation methods. We find some strikingly large effects of certain events on the occurrence of depression. We show that the results are of importance for the design of health care and labor market policy towards the elderly.

Death, Retirement, Income Loss, Disease, Depression, Health Indicators, Widowhood, Care, Panel Data, Endogeneity, Fixed Effects

Abstract:
We investigate the presence of moral hazard and advantageous or adverse selection in a market for supplementary health insurance. For this we specify and estimate dynamic models for health insurance decisions and health care utilization. Estimates of the health care utilization models indicate that moral hazard is not important. Furthermore, we find strong evidence for advantageous selection, largely driven by heterogeneity in education, income and health preferences. Finally, we show that ignoring dynamics and unobserved fixed effects changes the results dramatically.

advantageous selection, health care utilization, moral hazard, panel data, supplementary private health insurance

Abstract:
We investigate the presence of moral hazard and advantageous or adverse selection in a market for supplementary health insurance. For this we specify and estimate dynamic models for health insurance decisions and health care utilization. Estimates of the health care utilization models indicate that moral hazard is not important. Furthermore, we find strong evidence for advantageous selection, largely driven by heterogeneity in education, income and health preferences. Finally, we show that ignoring dynamics and unobserved fixed effects changes the results dramatically.

supplementary private health insurance, health care utilization, advantageous selection, moral hazard, panel data

Abstract:
We investigate the presence of moral hazard and advantageous or adverse selection in a market for supplementary health insurance. For this we specify and estimate dynamic models for health insurance decisions and health care utilization. Estimates of the health care utilization models indicate that moral hazard is not important. Furthermore, we find strong evidence for advantageous selection, largely driven by heterogeneity in education, income and health preferences. Finally, we show that ignoring dynamics and unobserved fixed effects changes the results dramatically.

supplementary private health insurance, health care utilization, advantageous selection, moral hazard, panel data

Abstract:
This paper explores the interrelation between health and work decisions of older workers. For this, two issues are of relevance. Firstly, health and work may be endogenously related because of direct effects of health on work and vice versa, and because of unobservables that may relate observed health and work outcomes. Secondly, social surveys usually contain self-assessed health measures and research indicates that these may be affected by endogenous, state-dependent, reporting behavior. A solution to the 'Health and Retirement Nexus' requires an integrated model for work decisions, health production and health-reporting mechanisms. We formulate such a model and estimate it on a longitudinal dataset of Dutch elderly.

Work, health, endogeneity, subjective health, state-dependent reporting errors

Abstract:
This Paper analyses the effects of macroeconomic conditions throughout life on the individual mortality rate. We estimate flexible duration models where the individual's mortality rate depends on current conditions, conditions earlier in life (notably during childhood), calendar time, age, individual characteristics, including individual socio-economic indicators, and interaction terms. We use individual data records from Dutch registers of birth, marriage, and death certificates, covering an observation window of unprecedented size (1812-1999). These are merged with historical data on macroeconomic and health indicators. The results indicate a strong effect of macroeconomic conditions during childhood on mortality at all ages. Those who are born in bad times on average have a high mortality rate throughout life, in particular during childhood itself and at ages above 50. Current macroeconomic conditions mostly have an effect on youths and on the elderly.

Abstract:
This paper analyzes the effects of macro-economic conditions throughout life on the individual mortality rate. We estimate flexible duration models where the individual's mortality rate depends on current conditions, conditions earlier in life (notably during childhood), calendar time, age, individual characteristics, including individual socio-economic indicators, And interaction terms. We use individual data records from Dutch registers of birth, marriage, and death certificates, covering an observation window of unprecedented size (1812-1999). These are merged with historical data on macro-economic and health indicators. The results indicate a strong effect of macro-economic conditions during childhood on mortality at all ages. Those who are born in bad times on average have a high mortality rate throughout life, in particular during childhood itself and at ages above 50. Current macro-economic conditions mostly have an effect on youths and on the elderly.

death, longevity, health, business cycle, recession, life expectancy, lifetimes, epidemics

Abstract:
The magnitude of the effect that health has on the retirement decision has long been studied. We examine the reverse relationship, whether or not retirement has a direct impact on later-life health. In order to identify the causal relationship, we use unexpected early retirement window offers to instrument for retirement behavior. They are legally required to be unrelated to the baseline health of the individual, and are significant predictors of retirement. We find that there is no negative effect of early retirement on men's health, and if anything, a temporary increase in self-reported health and improvements in health of highly educated workers. While this is consistent with previous literature using Social Security ages as instruments, we also find some evidence that anticipation of retirement might also be important, and might bias the previous estimates towards zero.

health, retirement, instrument, causal effect

Abstract:
The effect that health has on the retirement decision has long been studied. We examine the reverse relationship, whether retirement has a direct impact on later-life health. To identify the causal relationship, we use early retirement window offers to instrument for retirement. We find no negative effects of early retirement on men's health, and if anything, a temporary increase in self-reported health and improvements in health of highly educated workers. While this is consistent with previous literature using Social Security ages as instruments, we also find that anticipation of retirement might be important, and bias the previous estimates downwards.

retirement, depression, self-reported health, heart attack, cancer, diabetes, instrumental variables

Abstract:
This paper aims to explore the interrelation between health and work decisions of elderly workers, taking the various ways in which health and work can influence each other explicitly into account. For this, two issues are of relevance. Self-assessed health measures are usually at hand in empirical analyses and research indicates that these may be endogenous, state dependent, reporting behaviour. Furthermore, even if an objective health measure is used, it is not likely to be strictly exogenous to labour market status or labour income. Health and labour market variables are correlated because of unobserved individual-specific characteristics (e.g., investments in human capital and health capital) Moreover, one's labour market status is expected to have a (reverse) causal effect on health. A solution to the "Health and Retirement Nexus" requires an integrated model for work decisions, health production and health reporting mechanisms. We formulate such a model and estimate it on a longitudinal dataset of Dutch elderly.

Retirement, Health, Endogeneity, State Dependent Reporting Errors

Abstract:
This paper aims to exp1ore the interre1ation between hea1th and work decisions of e1der1y workers, taking the various ways in which hea1th and work can influence each other exp1icitly into account. For this, two issues are of re1evance. Se1f-assessed health measures are usually at hand in empirical analyses and research indicates that these may be affected by endogenous, state dependent, reporting behavior. Furthermore, even if an objective health measure is used, it is not likely to be strictly exogenous to labor market status or labor income. Health and labor market variables are correlated because of unobserved individual-specific characteristics (e.g., investments in human capital and health capital). Moreover, one's labor market status is expected to have a (reverse) causal effect on health. A solution to the "Health and Retirement Nexus" requires an integrated model for work decisions, health production and health reporting mechanisms. We formulate such a model and estimate it on a longitudinal dataset of Dutch elderly.

Retirement, health, endogeneity, state dependent reporting errors

Abstract:
Social surveys are often used to estimate unemployment duration distributions. Survey non-response may then cause a bias. We study this using a unique dataset that combines survey information of individual workers with administrative records of the same workers. The latter provide information on unemployment durations and personal characteristics of all survey respondents and non-respondents. We develop a method to empirically distinguish between two explanations for a bias in results based on only survey data: (1) selectivity due to related unobserved determinants of unemployment durations and non-response, and (2) a causal effect of a job exit on non-response. The latter may occur even in fully homogeneous populations. The methodology exploits variation in the timing of the duration outcome relative to the survey moment. The results show evidence for both explanations. We discuss implications for standard methods to deal with non-response bias.

non-response bias, unemployment measurement, hazard rate, sample selection, event history

Abstract:
This paper investigates the effects of intensified screening of disability insurance benefit applications. A large-scale experiment was setup where in 2 of the 26 Dutch regions case workers of the disability insurance administration were instructed to screen applications more intense. The empirical results show that intense screening reduces long-term sickness absenteeism and disability insurance applications. This provides evidence both for direct effects of the more intensive screening on work resumption during sickness absenteeism and for self-screening by potential disability insurance applicants. We do not find any spillover effects to the inflow into unemployment insurance. A cost-benefit analysis shows that the costs of the intensified screening are only a small fraction of its benefits.

Sickness absenteeism, policy evaluation, disability insurance, self-screening

Abstract:
This paper investigates the effects of intensified screening of disability insurance benefit applications. A large-scale experiment was setup where in 2 of the 26 Dutch regions case workers of the disability insurance administration were instructed to screen applications more intense. The empirical results show that intense screening reduces long-term sickness absenteeism and disability insurance applications. This provides evidence both for direct effects of the more intensive screening on work resumption during sickness absenteeism and for self-screening by potential disability insurance applicants. We do not find any spillover effects to the inflow into unemployment insurance. A cost-benefit analysis shows that the costs of the intensified screening are only a small fraction of its benefits.

disability insurance, sickness absenteeism, policy evaluation, self-screening, experiment

Abstract:
This paper focuses on the relation between the onset of disability and employment outcomes. We develop an event history model that includes unscheduled hospitalizations as a measure for unanticipated health shocks and estimate the model on data from the British National Child Development Study (NCDS). We show that such health shocks increase the likelihood of an onset of a disability by around 138%. However, health shocks are relatively rare events and therefore the larger part of observed disability rates result from gradual deteriorations in health. We find no direct effect of health shocks on employment outcomes. Using the health shock as an instrumental variable shows that the onset of a disability at age 25 causally reduces the employment rate at age 40 with around 21 percentage points. Our results show that early childhood conditions are important in explaining adult health and socioeconomic outcomes. Those who have experienced bad conditions during early childhood have higher rates of health deterioration during adulthood, are more likely to become non-employed and suffer from longer spells of non-employment during the course of life.

Disability, employment, early childhood conditions, health shocks, causality

Abstract:
We analyze the effect of being born in a recession on the mortality rate later in life in conjunction with social class. We use individual data records from Dutch registers of birth, marriage, and death certificates, covering the period 1815-2000, and we merge these with historical data on macro-economic outcomes and health indicators. We estimate duration models and inequality measures. The results indicate that being born in a recession increases the mortality rate later in life for most of the population. Lower social classes suffer disproportionally from being born in recessions. This exacerbates mortality inequality. This is not affected by social mobility: upward mobility does not vary much with the business cycle at birth. It turns out that the average long-run economic well-being of the family at birth, the transitory economic shocks at birth, and their interaction, are all relevant determinants of the mortality rate throughout the whole life.

death, longevity, recession, life expectancy, lifetimes, social inequality, social class

Abstract:
There is a concern that ordered responses on health questions may differ across populations or even across subgroups of a population. This reporting heterogeneity may invalidate group comparisons and measures of health inequality. This paper proposes a test for differential reporting in ordered response models which allows us to distinguish between cut-point shift and index shift. The method is illustrated using Canadian National Population Health Survey data. The McMaster Health Utility Index (HUI) is used as a more objective health measure than the simple 5-point scale of self-assessed health. We find clear evidence of index shifting and cut-point shifting for age and gender, but not for income, education or language.

health measurement, ordered response models, cut point shift, index shift, Canada

Abstract:
This paper investigates the impact of parental education on child health outcomes. To identify the causal effect we explore exogenous variation in parental education induced by a schooling reform in 1947, which raised the minimum school leaving age in the UK. Findings based on data from the National Child Development Study suggest that postponing the school leaving age by one year had little effect on the health of their offspring. Schooling did however improve economic opportunities by reducing financial difficulties among households. We conclude from this that the effects of parental income on child health are at most modest.

returns to education, intergenerational mobility, health, regression-discontinuity

Abstract:
This paper focuses on the relation between the onset of disability and employment outcomes. We develop an event history model that includes unscheduled hospitalizations as a measure for unanticipated health shocks and estimate the model on data from the British National Child Development Study (NCDS). We show that such health shocks increase the likelihood of an onset of a disability by around 138%. However, health shocks are relatively rare events and therefore the larger part of observed disability rates result from gradual deteriorations in health. We find no direct effect of health shocks on employment outcomes. Using the health shock as an instrumental variable shows that the onset of a disability at age 25 causally reduces the employment rate at age 40 with around 21 percentage points. Our results show that early childhood conditions are important in explaining adult health and socioeconomic outcomes. Those who have experienced bad conditions during early childhood have higher rates of health deterioration during adulthood, are more likely to become non-employed and suffer from longer spells of non-employment during the course of life.

Disability, early childhood conditions, employment, health shocks

Abstract:
This paper focuses on the relation between the onset of disability and employment outcomes. We develop an event history model that includes unscheduled hospitalizations as a measure for unanticipated health shocks and estimate the model on data from the British National Child Development Study (NCDS). We show that such health shocks increase the likelihood of an onset of a disability by around 138%. However, health shocks are relatively rare events and therefore the larger part of observed disability rates result from gradual deteriorations in health. We find no direct effect of health shocks on employment outcomes. Using the health shock as an instrumental variable shows that the onset of a disability at age 25 causally reduces the employment rate at age 40 with around 21 percentage points. Our results show that early childhood conditions are important in explaining adult health and socioeconomic outcomes. Those who have experienced bad conditions during early childhood have higher rates of health deterioration during adulthood, are more likely to become non-employed and suffer from longer spells of non-employment during the course of life.

disability, work, health shocks, event-history model, early childhood

Abstract:
Heterogeneity in reporting of health by socio-economic and demographic characteristics potentially biases the measurement of health disparities. We use anchoring vignettes to identify reporting heterogeneity in self reports on health for Indonesia, India and China. Correcting for reporting heterogeneity tends to reduce estimated disparities in health by age, sex (not Indonesia), urban/rural and education (not China) and to increase income disparities in health. Overall, while homogeneous reporting by socio-demographic group is significantly rejected, the results suggest that the size of the reporting bias in measures of health disparities is not large.

health measurement, vignettes, self-reported health, reporting heterogeneity

Abstract:
In labor markets with worker and firm heterogeneity, the matching between firms and workers may be assortative, meaning that the most productive workers and firms team up. We investigate this with longitudinal population-wide matched employer-employee data from Portugal. Using dynamic panel data methods, we quantify a firm-specific productivity term for each firm, and we relate this to the skill distribution of workers in the firm. We find that there is positive assortative matching, in particular among long-lived firms. Using skill-specific estimates of an index of search frictions, we find that the results can only to a small extent be explained by heterogeneity of search frictions across worker skill groups.

positive assortative matching, matched employer-employee data, productivity, skill, unobserved heterogeneity, sorting, fixed effects

Abstract:
Background: Nutrition in utero and infancy may causally affect health and mortality at old ages. Until now, very few studies have demonstrated long-Run effects on survival of early life nutrition, mainly because of data limitations and confounding issues. Methods: This paper investigates whether exposure to nutritional shocks in early life negatively affects longevity at older ages, using unique individual data and exploiting the exogenous variation implied by natural experiments. In particular, early nutritional conditions are instrumented by exposure to the potato famine of unprecedented severity that the Dutch faced in 1846-47. The individual data are from the Historical Sample of the Netherlands and are augmented by food price data and macro-economic data. The sample used in the study covers lifetimes of 398 individuals exposed and 1,342 individuals not exposed to severe famine during gestation and/or till age three. We compare non-parametrically the total and residual lifetimes of treated and controls per gender. We also estimate survival models in which we control for other individual characteristics and additional (early life) determinants of mortality. Results: Men exposed to severe famine during pregnancy (at least four months) and directly after birth have a significant lower residual life expectancy at age 50 than others, but not at earlier ages. We could not demonstrate any long-run effects for men exposed at ages 0-2 and for women. Conclusion: To our knowledge, this is the first evidence suggesting long-run effects of early nutritional stresses on mortality at old ages for men.

nutrition in early life, famine, longevity, natural experiments, survival analysis, mortality, food intake, developmental origins, fetal origins

Abstract:
This paper aims to assess the relative importance of differences in behavioural responses to financial incentives in explaining the observed variation in retirement behaviour across different types of households. We specify and estimate models for singles and married couples and estimate these on data from the Dutch Socio-Economic Panel. Model estimates are used to decompose the observed differences in retirement trends of the different demographic subgroups into differences in preferences and differences in the availability and generosity of the retirement options.

Optimal stopping, household retirement

Abstract:
This paper assesses the impact of a dramatic reform of the Dutch pension system on mental health, savings behavior and retirement expectations of workers nearing retirement age. The reform means that public sector workers born on January 1, 1950 or later face a substantial reduction in their pension rights while workers born before this threshold date may still retire under the old, more generous rules. We employ a unique matched survey and administrative data set comprising male public sector workers born in 1949 and 1950 and find strong ex ante effects on mental health for workers who are affected by the reform. This effect increases as birth dates approach the threshold date. Furthermore, the effects differ in accordance with worker characteristics. Finally, we find that the response of those affected by the reform is to work longer and to save more.

Abstract:
This paper assesses the impact of a dramatic reform of the Dutch pension system on mental health, savings behavior and retirement expectations of workers nearing retirement age. The reform means that public sector workers born on January 1, 1950 or later face a substantial reduction in their pension rights while workers born before this threshold date may still retire under the old, more generous rules. We employ a unique matched survey and administrative data set comprising male public sector workers born in 1949 and 1950 and find strong ex ante effects on mental health for workers who are affected by the reform. This effect increases as birth dates approach the threshold date. Furthermore, the effects differ in accordance with worker characteristics. Finally, we find that the response of those affected by the reform is to work longer and to save more.

mental health, retirement, pension reform, causal effect

Abstract:
We specify a model for the lifetimes of spouses and the dynamic evolution of health, allowing spousal death to have causal effects on the health and mortality of the survivor. We estimate the model using a longitudinal survey that traces many health status aspects over time, and that is linked to register data on the vital status of the individuals. The model takes account of selectivity in partners' mortality and health evolution. We find strong instantaneous effects of bereavement on mortality and on certain aspects of health. Individuals lose on average 12% of residual life expectancy after bereavement. Bereavement affects the share of healthy years in residual lifetime, primarily because healthy years are replaced by years with chronic diseases.

death, longevity, health care, disease, life expectancy, elderly couples, impairment

Abstract:
We study the effect of obesity on wages and employment, using data from the British NCDS. The results show a significant negative association between obesity and labor market outcomes even after controlling for a rich set of demographic, socioeconomic, environmental and behavioral variables. After instrumenting with parental obesity the associations are no longer significant. We show that the intergenerational correlation in obesity is mainly due to genetic variation. However, the instruments do not always pass the overidentification tests and are sometimes weak. We are therefore somewhat sceptical about using parental obesity as an instrument.

obesity, wages, employment, labor, endogeneity

Abstract:
Using longitudinal income-tax registers, we study how past labour market outcomes affect current labour market transition rates. We focus on hysteresis effects of the durations and incidence of previous spells out of work. We estimate flexible multi-state Mixed Proportional Hazard specifications for transition rates between employment, unemployment, and welfare/non-participation. Our main finding is that after longer periods of employment with high income, individuals' transition rates from unemployment to employment increase. Longer periods of non-employment generally decrease future transition rates to work, and sometimes also from work. The quantitative magnitude of persistency and hysteresis effects on inequality is modest.

duration analysis, hysteresis, inequality, wages, unemployment, hazard rates, employment, income, work

Abstract:
This paper focuses on the relation between the onset of disability and employment outcomes. We develop an event history model that includes accidents as a measure for unanticipated health shocks and estimate the model on data from the British National Child Development Study (NCDS). We show that experiencing such a health shock increases the likelihood of an onset of a disability by around 138%. However, health shocks are relatively rare events and therefore the larger part of observed disability rates result from gradual deteriorations in health. We find no direct effect of health shocks on employment outcomes. Using the health shock as an instrumental variable shows that the onset of a disability at age 25 causally reduces the employment rate at age 40 with around 21 percentage points. The effect is stronger for males and for workers with a higher Socio-economic background.

disability, work, health shock, causal effect

Abstract:
Obesity has been associated with inferior labour market outcomes. Although obesity is endogenous to labour market outcomes, few studies have addressed this issue in a convincing manner, however. This paper uses data from the NCDS to estimate the causal effect of obesity on labour market outcomes. The NCDS offers several distinct advantages for our purposes. First, using the rich information on family background, parental inputs, and cognitive abilities, we are able to control for some of the unobserved heterogeneity that previous studies have suffered from. Second, the data records the body size of the mother, which we use as an instrument for own body size. Third, we utilize the panel feature of the NCDS in order to remove some of the time-invariant unobserved heterogeneity, for instance the existence of common or correlated genes determining both obesity and employment.

Simple OLS results show a sizable and significant correlation between obesity and employment at age 42 for females and a less strong but significant correlation for males. Including controls for potentially important factors, such as family background, parental inputs, and cognitive ability does not affect the association between obesity and employment. Moving on to IV-estimation, we note that our IV-strategy hinges on the assumption that the non-genetic factors that determine obesity are not the same as those that determine labour market success. Prior twin- and adoption studies support the assumption that the correlation in body weight between biological relatives is due to genetics, while environmental factors within the household play no role. We make additional checks of this assumption by (1) examining if the strong correlation in body size between biological relatives is affected when controlling for a rich source of environmental factors during childhood and adolescence and (2) whether the correlation in body size between the respondent and his/her mother is different for adopted than for natural children. The results provide suggestive evidence that the body size of a biological relative mainly predicts genetic variation in body size, making it potentially useful as an instrument.

Next, we perform IV-estimation separately by gender on the employment probability as a function of obesity and a wealth of other factors, potentially affecting labour market outcomes. Instrumenting for obesity renders the previously found significant correlation insignificant.

Finally, there still exists the possibility that the same genes that are related to obesity are also directly related to labour market outcomes, thereby posing a threat to our IV-strategy. We therefore utilise the panel feature of the NCDS and conduct analyses on first differences, in order to remove some of the unobserved heterogeneity. Finally, we instrument the change in obesity with the mother's obesity status in levels and, again, find no significant effect of obesity on employment.

obesity, body mass index, health, labour, employment, endogeneity