Workplace Injuries and Receipt of Benefits From Workers' Compensation and Social Security Disability Insurance.

OBJECTIVE: We examine whether workers who experience permanently disabling injuries covered by workers' compensation (WC) end up on Social Security Disability Insurance (SSDI) and whether Social Security Administration (SSA) seems to offset WC payments for permanently disabling injuries against SSDI benefits, when appropriate. Methods: We capture data on WC benefit receipt from the Health and Retirement Study and link it to SSA data on WC and SSDI recipients to study descriptive information on these questions. Results: We find that SSA seems to be missing data on WC benefits for a sizable share of recipients of WC benefits and that the frequency with which SSDI benefits are reduced because of the WC offset seems surprisingly low. Conclusions: For a variety of reasons, WC benefits for permanently disabling injuries may not be appropriately offset against SSDI benefits, possibly shifting the cost of these workplace injuries to SSDI.

Does Ageist Language in Job Ads Predict Age Discrimination in Hiring?

We study the relationships between ageist stereotypes - as reflected in the language used in job ads - and age discrimination in hiring, exploiting the text of job ads and differences in callbacks to older and younger job applicants from a resume (correspondence study) field experiment (Neumark, Burn, and Button, 2019). Our analysis uses computational linguistics and machine learning methods to examine, in a field-experiment setting, ageist stereotypes that might underlie age discrimination in hiring. In so doing, we develop methods and a framework for analyzing textual data, highlighting the usefulness of various computer science techniques for empirical economics research. We find evidence that language related to stereotypes of older workers sometimes predicts discrimination against older workers. For men, we find evidence that age stereotypes about all three categories we consider - health, personality, and skill - predict age discrimination, and for women, age stereotypes about personality predict age discrimination. In general, the evidence that age stereotypes predict age discrimination is much stronger for men, and our results for men are quite consistent with the industrial psychology literature on age stereotypes.

Strengthen Age Discrimination Protections to Help Confront the Challenge of Population Aging.

A policy imperative in light of population aging in the United States is to increase employment among older workers. However, age discrimination, especially in hiring, can impede efforts to encourage older people to work longer. This commentary reviews evidence on age discrimination and laws prohibiting age discrimination, and discusses recent court rulings that affect the strength of these laws. Based on this review, the commentary proposes a number of policy changes to reduce age discrimination in hiring, including: increasing damages under the Age Discrimination in Employment Act (ADEA) to match the larger damages that some states allow; amending the ADEA to clarify that claims based on statistical differences in the effects of employer policies ("disparate impact claims") are allowed for hiring discrimination, and that the standard for establishing discrimination is not that age was the determining factor in creating the disparity (the "but for" age criterion), rather that it was simply a contributing factor; amending the ADEA to allow intersectional claims regarding age and other group membership - especially regarding discrimination against older women; extending affirmative action for federal contractors to older workers; and considering strengthening the Americans with Disabilities Act (ADA).

Relative Sizes of Age Cohorts and Labor Force Participation of Older Workers.

We study the effects of the size of older cohorts on labor force participation and wages of older workers in the United States. We use panel data on states, treating the age structure of the population as endogenous, owing to migration. When older cohorts (50-59 or 60-69) are large relative to a young cohort (aged 16-24), the evidence fits the relative supply hypothesis. However, when older cohorts are large relative to 25- to 49-year-olds, the evidence points to a relative demand shift. Thus, we need a more nuanced view than simply whether the older cohort is large relative to the population: the cohort that they are large relative to matters.

Do State Laws Protecting Older Workers from Discrimination Reduce Age Discrimination in Hiring? Evidence from a Field Experiment.

We conduct a resume field experiment in all U.S. states to study how state laws protecting older workers from age discrimination affect age discrimination in hiring for retail sales jobs. We relate the difference in callback rates between old and young applicants to state variation in age and disability discrimination laws. These laws could boost hiring of older applicants, although they could have the unintended consequence of deterring hiring if they increase termination costs. In our preferred estimates that are weighted to be representative of the workforce, we find evidence that there is less discrimination against older men and women in states where age discrimination law allows larger damages, and more limited evidence that there is lower discrimination against older women in states where disability discrimination law allows larger damages. Our clearest result is that these laws do not have the unintended consequence of lowering callbacks for older workers.

The effect of primary care visits on other health care utilization: A randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.

We conducted a randomized controlled trial, enrolling low-income uninsured adults in Virginia (United States), to determine whether cash incentives are effective at encouraging a primary care provider (PCP) visit, and at lowering utilization and costs. Subjects were randomized to four groups: untreated controls, and one of three incentive arms with incentives of $0, $25, or $50 for visiting a PCP within six months of group assignment. We used the exogenous variation generated by the experiment to obtain causal evidence on the effects of a PCP visit. We observed modest reductions in non-urgent emergency department visits and increased outpatient visits, but no reductions in overall costs. These findings in utilization are consistent with the expectation that PCPs offer an alternative to the emergency department for non-emergent conditions. Total costs did not decline because any savings from avoiding the emergency department were offset by increased outpatient utilization.

The Effects of Provider Choice Policies on Workers' Compensation Costs.

OBJECTIVE: To examine the effects of provider choice policies on workers' compensation medical and indemnity costs. DATA SOURCES/STUDY SETTING: Pooled cross-sectional analysis of administrative claims records for workers with work-related injuries primarily in 2007-2010 across 25 states (n = 4,489,729). STUDY DESIGN: We used linear and quantile regression analyses to evaluate differences in claim costs (medical and indemnity) based on whether policies give employers or injured workers control over the choice of provider. PRINCIPAL FINDINGS: We find no difference in average medical costs by provider choice policies, although a distributional analysis indicates higher developed medical costs for the costliest back injury cases in states where workers control provider choice. The evidence for indemnity costs is similar, although the point estimates also indicate (statistically insignificantly) higher average costs when policies give workers more control of the choice of provider. CONCLUSIONS: Our nuanced evidence suggests that policymakers seeking to reduce workers' compensation costs may need to focus on the highest cost cases in states where policy gives workers more control over the choice of provider, rather than the simpler and broader issue of whether policy gives workers or employers more control.

Does Eliminating the Earnings Test Increase the Incidence of Low Income Among Older Women?

Reducing or eliminating Social Security's retirement earnings test (RET) can encourage labor supply of older individuals receiving benefits. However, these reforms can encourage earlier claiming of Social Security benefits, permanently lowering future benefits. We explore the consequences, for older women, of eliminating the RET from the full retirement age to age 69 (in 2000), relying on the intercohort variation in exposure to changes in the RET to estimate these effects. The evidence is consistent with the conclusion that eliminating the RET increased the likelihood of having very low incomes among women in their mid-70s and older-ages at which the lower benefits from claiming earlier could outweigh higher income in the earlier period when women or their husbands increased their labor supply.

Barriers to Later Retirement for Men: Physical Challenges of Work and Increases in the Full Retirement Age.

Policy changes intended to delay retirements of older workers and extend their work lives may run up against barriers owing to rising physical challenges of work as people age. We examine whether physical challenges at work influence employment transitions of older male workers in the age range for which public policy is trying to extend work lives and whether older male workers are able to mitigate these challenges while still remaining employed. The evidence indicates that physical challenges pose a barrier to extending work lives, although some older male workers with physically demanding jobs are able to mitigate these demands-either at new jobs or with the same employer. Our findings suggest that greater accommodation of physical challenges faced by older workers would likely increase the success of policies intended to induce later retirement.

Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage.

In a randomized controlled trial, we studied low-income adults newly covered by a primary care program to determine whether a cash incentive could encourage them to make an initial visit to a primary care provider. Subjects were randomly assigned to one of four groups: three groups whose members received $10 to complete a baseline survey during an interview and who were randomized to incentives of $50, $25, or $0 to visit their assigned primary care provider within six months after enrolling in the study; and a nonincentivized control group not contacted by the research team. Subjects in the $50 and $25 incentive groups were more likely to see a primary care provider (77 percent and 74 percent, respectively), compared to subjects in the $0 incentive group (68 percent). The effects of the intervention were about twice as large when we compared the proportions of subjects in the $50 and $25 incentive groups who visited their providers and the proportion in the nonincentivized group (61 percent). Cash incentive programs may steer newly covered low-income patients toward primary care, which could result in improved health outcomes and lower costs.

Does Protecting Older Workers From Discrimination Make It Harder to Get Hired? Evidence From Disability Discrimination Laws.

We explore the effects of disability discrimination laws on hiring of older workers. A concern with antidiscrimination laws is that they may reduce hiring by raising the cost of terminations and-in the specific case of disability discrimination laws-raising the cost of employment because of the need to accommodate disabled workers. Moreover, disability discrimination laws can affect nondisabled older workers because they are fairly likely to develop work-related disabilities, but are generally not protected by these laws. Using state variation in disability discrimination protections, we find little or no evidence that stronger disability discrimination laws lower the hiring of nondisabled older workers. We similarly find no evidence of adverse effects of disability discrimination laws on hiring of disabled older workers.

WORK CONTINUATION WHILE TREATED FOR BREAST CANCER: THE ROLE OF WORKPLACE ACCOMMODATIONS.

Given the short- and long-term disabilities associated with breast cancer and its treatment, the authors investigate the influence of workplace accommodations on the employment and hours worked of women newly diagnosed with breast cancer. Accommodations that allow women to work fewer hours or that ease the burden of work could also generate health benefits by reducing workplace demands and allowing women more time to tend to treatment needs and recovery. In prior research, the authors found modest labor supply impacts on employment for this group of women. Evidence from this study suggests that some accommodations are associated with fewer hours worked, while some are associated with higher employment or hours. In addition, some of the accommodations that may affect hours of work-sometimes positively and sometimes negatively-are associated with positive health benefits.

Does employer-provided health insurance constrain labor supply adjustments to health shocks? New evidence on women diagnosed with breast cancer.

Employment-contingent health insurance may create incentives for ill workers to remain employed at a sufficient level (usually full-time) to maintain access to health insurance coverage. We study employed married women, comparing the labor supply responses to new breast cancer diagnoses of women dependent on their own employment for health insurance with the responses of women who are less dependent on their own employment for health insurance, because of actual or potential access to health insurance through their spouse's employer. We find evidence that women who depend on their own job for health insurance reduce their labor supply by less after a diagnosis of breast cancer. In the estimates that best control for unobservables associated with health insurance status, the hours reduction for women who continue to work is 8 to 11% smaller. Women's subjective responses to questions about working more to maintain health insurance are consistent with the conclusions from observed behavior.

The effects of health shocks on employment and health insurance: the role of employer-provided health insurance.

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.

Lessons for coverage expansion: a Virginia primary care program for the uninsured reduced utilization and cut costs.

The Affordable Care Act will expand health insurance coverage for an estimated thirty-two million uninsured Americans. Increased access to care is intended to reduce the unnecessary use of services such as emergency department visits and to achieve substantial cost savings. However, there is little evidence for such claims. To determine how the uninsured might respond once coverage becomes available, we studied uninsured low-income adults enrolled in a community-based primary care program at Virginia Commonwealth University Medical Center. For people continuously enrolled in the program, emergency department visits and inpatient admissions declined, while primary care visits increased during the study period. Inpatient costs fell each year for this group. Over three years of enrollment, average total costs per year per enrollee fell from $8,899 to $4,569--a savings of almost 50 percent. We conclude that previously uninsured people may have fewer emergency department visits and lower costs after receiving coverage but that it may take several years of coverage for substantive health care savings to occur.

Differences in breast cancer diagnosis and treatment: experiences of insured and uninsured women in a safety-net setting.

To explore how well the safety net performs at eliminating differences in diagnosis and treatment of insured and uninsured women with breast cancer, we compared insured and uninsured women treated in a safety-net setting. Controlling for socioeconomic characteristics, uninsured women are more likely to be diagnosed with advanced disease, requiring more extensive treatment relative to insured women, and also experience delays in initiating and completing treatment. The findings suggest that, despite the safety-net system, uninsured women with breast cancer are likely to require more costly treatment and to have worse outcomes relative to insured women with breast cancer.

SPATIAL MISMATCH OR RACIAL MISMATCH?

We contrast the spatial mismatch hypothesis with what we term the racial mismatch hypothesis - that the problem is not a lack of jobs, per se, where blacks live, but a lack of jobs where blacks live into which blacks are hired. We first report new evidence on the spatial mismatch hypothesis, using data from Census Long-Form respondents. We construct direct measures of the presence of jobs in detailed geographic areas, and find that these job density measures are related to employment of black male residents in ways that would be predicted by the spatial mismatch hypothesis - in particular that spatial mismatch is primarily an issue for low-skilled black male workers. We then look at mismatch along not only spatial lines but racial lines as well, by estimating the effects of job density measures that are disaggregated by race. We find that it is primarily black job density that influences black male employment, whereas white job density has little if any influence on their employment. The evidence implies that space alone plays a relatively minor role in low black male employment rates.

Employment and cancer: findings from a longitudinal study of breast and prostate cancer survivors.

We discuss how cancer affected the employment of almost 800 employed patients who participated in a longitudinal study. The greatest reduction in patients' labor supply (defined as employment and weekly hours worked) was observed 6 months following diagnosis. At 12 and 18 months following diagnosis, many patients returned to work. Based on these and other findings related to patients' employment situations, we suggest 4 areas for future research: 1) collection of employment information in cancer studies; 2) research into racial and ethnic minority patients and employment outcomes; 3) interventions to reduce the effects of cancer and its treatment on employment; and 4) investigations into the influence of employment-contingent health insurance on cancer treatment and recovery.

Employment-contingent health insurance, illness, and labor supply of women: evidence from married women with breast cancer.

We examine the effects of employment-contingent health insurance (ECHI) on married women's labor supply following a health shock. First, we develop a theoretical framework that examines the effects of ECHI on the labor supply response to a health shock, which suggests that women with ECHI are less likely to reduce their labor supply in response to a health shock, relative to women with health insurance through their spouse's employer. Second, we empirically examine this relationship based on labor supply responses to breast cancer. We find that health shocks decrease labor supply to a greater extent among women insured by their spouse's policy than among women with health insurance through their own employer, suggesting that ECHI creates incentives to remain working when faced with a serious illness.

Combining registry, primary, and secondary data sources to identify the impact of cancer on labor market outcomes.

Some cancers are rapidly becoming chronic conditions that are more and more often diagnosed in working-age individuals. The authors developed a research agenda to study the labor market outcomes attributable to detection and treatment for cancer, and research design and data collection strategies to improve upon other research on these questions. In this article, they describe their approach to combining secondary data sources, primary data collection, and cancer registry data to evaluate the impact cancer has on labor market outcomes such as employment, hours worked, wages, and health insurance. They then critically assess how well their study design and data collection strategy accomplished its objectives. The intention is to offer guidance on how researchers, who are interested in the economic consequences of cancer, as well as of other chronic conditions, might develop and execute studies that examine labor market outcomes. As more attention is placed on the economic aspects of disease, the methods used to estimate productivity loss and other economic outcomes attributable to these conditions require careful scrutiny so that reliable findings can be used to shape health care decisions and policy.