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Income, health, and health insurance: Longitudinal health selection in logged income by health insurance status in Canada. Conference for New Researchers, McGill University, february 2007

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(1)

Income, Health and Health 

Insurance

H Longitudinal Health Selection in  logged Income by Health Insurance  H ealth Stra Status in Canada tification

(2)

Health Stratification: Outline

Health Stratification: Outline

• Theoretical UnderpinningsTheoretical Underpinnings

– Health Inequalities, health insurance, selection  and intergenerational transmission

and intergenerational transmission • Data M th d l i l Q ti H • Methodological Questions – Fixed effects and OLS H ealth Stra • Results • Conclusions tification 2 Funding for this project was provided by the Quebec Inter‐ university Centre for Social Statistics (QICSS)

(3)

Assumptions and Health

Assumptions and Health

• Being healthy means more now than it everBeing healthy means more now than it ever 

has before

• It relates to more of our lives and more of our

• It relates to more of our lives, and more of our  lives rotate around our health If h l h i bi l i l li H • If health is a biological reality as some say,  then why bother worrying1? H ealth Stra • Is there some kind of gain inherent to health? • Why is health so precious2? tification y p

(4)

Health Selection

A few researchers are beginning to realize

Health Selection

A few researchers are beginning to realize  that health may help create socioeconomic  inequality1, 2 • This Healthy Worker effect may be prominent  throughout the life course H • These studies do find a relationship, but none  adequately account for selection bias H ealth Stra • Very little attention has been paid to the role  that health insurance plays in this relationship tification 4 1(Hurd & Kapteyn 2003), 2(Mulatu & Schooler 2002)

(5)

Healthcare Cares?

Healthcare Cares?

• In Canada we generally consider ourselves toIn Canada we generally consider ourselves to 

have a universal healthcare system

Universal coverage only covers Medically

Universal coverage only covers Medically 

Necessary procedures – inequality exists

S l l i b d H • Supplemental insurance covers a broader  range of medical procedures H ealth Stra • These extra benefits may protect people in  times of illness tification

(6)

Problem

Problem

• Explore the effect that health has in creatingExplore the effect that health has in creating 

stratification amongst working‐aged  individuals

individuals

Assess the impact of health insurance in 

mediating this effect

H mediating this effect • Control for, and assess the part that selection  bi h i hi f ifi i H ealth Stra bias has in this type of stratification tification 6

(7)

Data

• Used the Survey of Labour and Income Dynamics 

Data

Used t e Su ey o abou a d co e y a cs (SLID), collected by Statistics Canada and  accessed through QICSS • The dataset is a six‐year refreshing household  panel dataset H • Analyses were taken from the 1999 – 2002 years • Missing data are excluded listwise H ealth Stra • Only working‐aged individuals, here defined as  between 18 and 65 years of age, were included tification

(8)

Measures: Income and Health

• Measure of income from all types of employment

Measures: Income and Health

easu e o co e o a types o e p oy e t – Transformed onto a logarithmic scale • Health was operationalized using self‐rated p g health – Has been assumed to be continuous H – This measure, while not “objective”, predicts  mortality1

– All analyses were run using dummy constructs and

H ealth Stra – All analyses were run using dummy constructs and  categorical equivalents of health, to no avail – Higher scores on health indicate poorer health tification 8 1(Mossey & Shapiro, 1982)

(9)

Health Insurance

• Everyone in the sample has been assumed to

Health Insurance

Everyone in the sample has been assumed to  have basic public health coverage

• Starting in 1999 respondents were asked

• Starting in 1999, respondents were asked  whether they had supplemental health  insurance H insurance • Thus, health insurance is dichotomous in  h l H ealth Stra these analyses tification

(10)

Methods

• For this study I compare OLS regression with 

Methods

y p g fixed effects regression • I separate all analyses by age group • Control for demographic variables, nesting the  health variables within this relationship

• I use robust standard errors to control for

H • I use robust standard errors to control for  heteroscedasticity, and I cluster around  household H ealth Stra • Analyses are done using lagged health OLS  models, and Fixed Effects regression to control  for selection bias

tification

for selection bias

(11)

Descriptive Statistics

Descriptive Statistics

Descriptive Statistics

18 – 29 30 – 49 50 – 65  18 – 29 30 – 49 50 – 65 

Health 1.875 2.117 2.286 Mar Stat

PHI 0.356 0.725 0.711 Married 0.256 0.766 0.786 Income 9 081 10 111 9 757 Single 0 708 0 118 0 056 Income 9.081 10.111 9.757 Single 0.708 0.118 0.056 Age 23.261 40.056 55.276 Widow. 0.000 0.004 0.038 HS 0.462 0.286 0.522 Divor. 0.005 0.060 0.090 H >HS 0.439 0.597 0.256 Separ. 0.031 0.052 0.030 Sex 0.523 0.503 0.493 HHSize 3.157 3.350 2.513 H ealth Stra Employ 0.600 0.878 0.800 tification

(12)

Results!

Results!

OLS Regressing Income on Nested Health and Health Insurance by Age Group

Health1 Coverage1 Interact.1 N ΔR2

18 – 29  Health ‐0.165* ‐0.159* ‐0.194* Ind =2720 *** PHI 0.599*** 0.401 *** PHI*SRH 0 102 HH =2399 PHI SRH 0.102 HH  2399 30 – 49 Health ‐0.014 ‐0.013 ‐0.089*** Ind =5910 *** PHI 0.623*** 0.375*** *** H PHI*SRH 0.117** HH =4464 50 – 65  Health ‐0.057* ‐0.056*** ‐0.192*** Ind =2609 *** PHI 0.937*** 0.460** *** H ealth Stra PHI*SRH 0.209*** HH =2146 *** tification 12 1Controls: age, gender, education, employment  status, marital status, occupation, and household size

(13)

Fixed Effects

Fixed Effects

Fixed Effects Models of Income on Health by Age Group 

Health1 Coverage1 Interact.1 N ΔR2

18 – 29  Health 0.033 0.031 0.001 Ind =2720 *** PHI 0.495*** 0.336*** Obs=9130 *** PHI*SRH 0086 HH =2399 H PHI SRH 0086 HH  2399 30 – 49 Health ‐0.138*** ‐0.130*** ‐0.235** Ind =5910 *** PHI 0.741*** 0.426* Obs=9130 *** H

ealth Stra PHI*SRH 0.146 HH =2399

50 – 65  Health ‐0.263*** ‐0.233*** ‐0.581*** 2609 ***

PHI 0.887*** ‐0.305 Obs=9130 ***

tification

(14)

Conclusions

Conclusions

• Health is an important predictor of income in ea t s a po ta t p ed cto o co e Canada – These effects are important both as a selector, and  when dealing with health shocks over the life course • More importantly, for Canadians, income 

depends on health depending on insurance

H

depends on health depending on insurance  status

• This suggests that health coverage is integral to

H ealth Stra • This suggests that health coverage is integral to  the economic well‐being of Canadians,  particularly as they age tification p y y g 14

(15)

Limitations and Future Research

How universal is healthcare in Canada?

Limitations and Future Research

How universal is healthcare in Canada?

– No healthcare question, only supplemental

• Some concerns of selection bias in FixedSome concerns of selection bias in Fixed 

Effects – Do people change their health depending on what  H p p g p g they start at? • Future research should consider the effects of  H ealth Stra health on income in differing health regimes • Type of occupation should also be considered tification

(16)

The End

H

The End

H ealth Stra tification 16

(17)

Table 4

Table 4

Longitudinal One‐way Analysis: R2 18 – 29 30 – 49 50 – 65 18 29 30  49 50  65  Health 0.571 0.602 0.637 PHI 0.601 0.701 0.723 H Income 0.538 0.629 0.605 Educ. 0.778 0.970 0.988 Mar Stat 0.644 0.819 0.924 H ealth Stra Employ 0.573 0.488 0.499 HHSize 0.745 0.906 0.881 • Considering if there is enough change in the  measures tification

(18)

Fixed Effects Transformation

Fixed Effects Transformation

HH

ealth Stra

•Here ν is the time invariant fixed individual

tification Here ν is the time invariant fixed individual 

effects in the error term

ε is the changing part of the error term

18

(19)

HH

ealth Stra

(20)

HH

ealth Stra

tification

(21)

HH

ealth Stra

Figure

Table 4Table 4 Longitudinal One‐way Analysis: R 2 18 – 29 30 – 49 50 – 6518 2930 4950  65  Health 0.571 0.602 0.637 PHI 0.601 0.701 0.723 H Income 0.538 0.629 0.605Educ.0.7780.9700.988 Mar Stat 0.644 0.819 0.924H ealth Stra Employ 0.573 0.488 0.499 HHSize

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