1、 外文翻译 原文 “Men with Health Insurance and the Women Who Love Them: the Effect of a Husbands Retirement on His Wifes Health Insurance Coverage” Material Source: http:/deepblue.lib.umich.edu/bitstream/2027.42/49335/3/wp131.pdf Author: Jody Schimmel Abstract Health insurance coverage in the years prior t
2、o retirement is particularly important because it protects the household from the financial risks of uninsurance as well as the health consequences of delaying care while uninsured. While results from the retirement “job lock” literature show that those who would lack coverage after retirement conti
3、nue to work to maintain benefits, little work has explored the types of health insurance choices made by couples after retirement. It may be difficult for a married man to coordinate continuous coverage for a younger wife whose primary source of coverage has been from the husband, and thus household
4、s may pay more for non-group coverage or be exposed to the risks of uninsurance. This paper studies a panel of married couples from the 1992-2004 waves of the Health and Retirement Study (HRS) to study the types of health insurance decisions households make around the time of retirement. Results ind
5、icate that households seem to do well at avoiding uninsurance at the time of retirement, but may make high cost choices in order to insure the wife. Men switch into Medicare or coverage from their wife at retirement if they lose their own coverage, but a large fraction of women take-up privately pur
6、chased coverage. In fact, the transition from husbands coverage to privately purchased coverage is twice as large in periods when the husband retires than otherwise. Transitions to uninsurance are lower in periods of retirement than at other times, suggesting that men continue to work if either spou
7、se would lose coverage. Though less risky, insurance purchased in the non-group market is expensive relative to employer-sponsored coverage. Thus, married households may need to increase savings to pay for health insurance that bridges the gap until the wife can claim Medicare at age 65. Introductio
8、n It has been documented that men who are eligible for employer-sponsored health insurance after their retirement are more likely to retire than those who do not have such coverage. Recently, work by Blau and Gilleskie (2006) and Kapur and Rogowski(2006),addressed this same issue from the household
9、perspective, incorporating other findings that have shown that couples make their health insurance and retirement choices jointly as a couple, not as individuals. By expanding the retirement “job lock” literature to include the insurance coverage of both spouses, these papers have made important con
10、tributions to the understanding of household retirement behavior. Despite retirement job lock at the individual and household levels, little work has studied the types of health insurance choices couples make once retirement occurs. Medicare coverage is available beginning at age 65 for most in the
11、United States, but most men retire years prior to reaching that age of eligibility. Many expect to receive retiree coverage from their former employer to bridge the gap until age 65, but they may discover upon retiring that such coverage is an unaffordable expense in retirement. In married household
12、s where retiree benefits are available for the husband, similar coverage may be unavailable or unaffordable to provide coverage to the wife. In situations where retiree coverage is altogether unavailable, a husband could delay his retirement until age 65 until eligible for Medicare. While that would
13、 ensure continuous coverage for him, if he is older, his retirement at age 65 could leave his wife without the coverage she had gotten from him. Thus, there are many possible reasons why expensive or risky health insurance choices may be made in the period of time between retirement and the Medicare
14、 eligibility that occurs at age 65 for each spouse. This paper explores the household health insurance decisions of married couples in the years after a husbands retirement using a panel of respondents from the 1992-2004 Health and Retirement Study (HRS). Because health insurance transitions are not
15、 usually modeled as an outcome variable, much of the work in this paper is descriptive, and its main purpose is to provide evidence about the health insurance of both spouses in a married couple around retirement. In particular, emphasis is placed on the health insurance transitions of individuals w
16、ho were covered by the husbands health insurance before his retirement, because these are the 2 people who are most likely to be affected by the mans decision to retire. Health insurance in the years among those who are late middle-aged have been shown to be volatile (Sudano and Baker, 2005), and th
17、is paper assesses the extent to which that volatility is a particular consequence of the decision to retire. Periods in which a retirement event is not observed are as used as a “control group” for the types of insurance transitions we would expect to observe if retirement were not driving any chang
18、es in coverage. If the relative rate of transition into more expensive or risky forms of health insurance states such as non-group coverage or uninsurance are higher in the periods when retirement is observed, or if the transitions for wives are different for the wives than their husband, this may s
19、uggest that households are not fully considering the health insurance choices for both spouses when choosing the husbands retirement date. Descriptive evidence and results from multinomial logit models of health insurance transitions among those who had coverage from the husbands employer prior to h
20、is retirement indicate that a large fraction of both husbands and wives maintain coverage from the husbands employer after he leaves his job. This corresponds well to tabulations from HRS cross-sections indicate that about two-thirds of those with employer-sponsored coverage from their own job are a
21、lso eligible for retiree health benefits. It also suggests that most retiree plans offer coverage to spouses who are currently covered by the plan. However, around fifty percent of those who had coverage from the husband prior to his retirement transition to a different insurance state in the period
22、 after he retires. Almost half of all men who lose their employersponsored health insurance have Medicare in the next period and one quarter take up coverage from their wifes employer sponsored plan. This suggests that a mans decision to retire is partially driven by his eligibility for Medicare, wh
23、ich is consistent with the job-lock and structural models of retirement. For women, the story is quite different. Because women are generally younger than their husband, they are not eligible for Medicare upon his retirement. Only one-quarter of women who lose coverage from their husband switch to M
24、edicare in the period after he retires. An additional third are able to take-up coverage from their own employer, coverage that they either already had or were able to opt into upon losing coverage from their husband. While transitions between employer plans or to Medicare will not significantly inc
25、rease household health insurance costs, transitions to non-group coverage or uninsurance will be costly. Twenty percent of married women and thirteen percent of married men who had relied on the husbands coverage prior to his retirement take-up privately purchased coverage in the 3 period following
26、his retirement. For women, this rate of transition is twice as large as in periods when the husband does not retire, for men it is approximately the same. Regression results confirm that transitions to non-group coverage are substantially higher in periods when the husband retires compared to otherw
27、ise, and that purchased insurance is the most common transition among women who lose coverage from their husband. While the HRS does not specifically ask about COBRA take-up, it does not appear that the increase in purchased coverage is owing to that coverage, since purchased insurance rates remain
28、high in the next period, even after COBRA would have been exhausted. Among both married men and women, 16 percent of those who previously had employer coverage become uninsured, a lower rate than in periods of non-retirement. Thus, it appears that households recognize the risk-reducing aspects of he
29、alth insurance coverage and make retirement decisions based on the availability of coverage, even if the choices made are quite expensive. 译文 “妇女们爱有健康保险的男人们，妻子的健康保险责任范围是丈夫退休依靠的效应 ” 资料来源 :http:/deepblue.lib.umich.edu/bitstream/2027.42/49335/3/wp131.pdf 作者： Jody Schimmel 摘要 在退休前购买健康保险是十分重要的，因为它保护没有保障的
30、金融风险，以及因为没有投保而使家庭拖延护理健康所造成的后果。虽然退休结果“职业锁定”文献显示，那些退休后享受不到保障的人士会在退休后继续工作维护福利，关于退休后夫妻对健康保险种类的选择的研究探索工作也是比较的少的，这对于协调年轻妻子的主要连续保障 来自丈夫的已婚男子是十分困难的，因此家庭需要支付更多的非集体性质的保障或者面临未受保障的风险。本文对从健康和退休研究（ HRS）中的 1992-2004年间的家庭中关于家庭围绕退休时间对于保险种类的选择所做出决定进行了研究。结果表明，家庭在退休时期对于避免未保险的情况做得很好，但为了保障妻子可能会有更高成本的选择。 当男人退休时失去自己的保险的时候，
31、转向医疗保险制度或者他们妻子的保障的时候，相当一部分的妇女采取行动自费购买保险。 事实上，在这个改变的时期，在退休时期自费购买的费用是其他任何时期丈夫的保障范围两倍大。 在退休时期转向不保险的可能性比其他任何时期都还要少，这意味着当配偶中的任何一方失去保障，丈夫将要继续工作。虽然风险较低，相对于雇主赞助的保障来说，非团体性保险购买的费用是比较昂贵的。因此，已婚的家庭可能需要增加储蓄来支付医疗保险，除非该产品可以填补妻子到 65岁可以索取医疗保险的空白。 导言 据记载，有资格获得雇主资助的健康保险的男人在比那些没有享受雇主资助健康保险的人更希望退休。最近， Blau and Gilleskie
32、(2006) 和 Kapur and Rogowski(2006)，针对从家庭的角度来 看同样的问题，并有其他调查也有表明，夫妇做他们的健康保险和退休选择的时候是 考虑到夫妻双方的情况的 ，而不是作为单个 个人 而做的 。通过扩 充 退休 “职业锁定 ”文学 ， 包括配偶双方的保险覆盖面，这些文章对家庭退休的行为的理解做出了重要的贡献。 尽管退休 工作 的 在 个人和家庭 的各个层面都有 锁定， 但是 很少 有 研究工作研究夫妻退休后的健康保险种类 的 选择。在美国大多数医疗保险覆盖面是 65岁开始提供 的 ，但大多数人的退休年龄比到达这一合适的退休年龄要早。许多人期望在退休到 65 岁这段时
33、间能够由原来的雇主帮忙支付保险费，但他们退休时可能会发现 这些 保障 在退休时期是比较难以承受的负担费用。在已婚家庭中，退休的福利由丈夫享有，类似的覆盖面对于妻子的保障可能无法使用或无法负担。在退休人员退休保障完全无法保障的情况下，丈夫可能会推迟到享有医疗保险资格的 65 岁退休。虽然这将确保连续的保障他，如果他更老的时候，他的妻子会因为他在 65 岁退休而变得没有保障。因此，这里有很多种可能使得为什么昂贵或有风险的健康保险的会在退休和在配偶享有医疗体制保障的时候 而做出 选择。 本文使用从 1992-2004 年健康和退休小组研究会中的受访者探讨在丈夫退休后已婚夫妇的家庭医疗保险选择的决定。
34、由于健康保险过渡通常不作为建模结果变量，本文大部分内容是描述性的，其主要目的是提供关于已婚夫妇在夫妻双方围绕医疗保险的证明。特别是，重点在 于 丈夫退休前丈夫的健康保险保障关于个人保险的过渡，这是因为两个人中最有受影响的是可能是受男子的 做出 退休决定的影响。健康保险，在那些将近中年的被证明是不稳定，容易变动的（苏丹和贝克， 2005 年），本文评估到波动性是退休决定后的特殊后果。把在退休时期没有被观察到的时候作为 “可控制的小组 ”作为我们 预期的观察退休在保障方面不会操纵并引起任何变化的保险转变。当退休是可预见性的时候，如果相对的比率转向健康保险状态更贵或者更具风险的形式，比如：在一段时期
35、的非团体保障或者未保障的更高的时候。或者如果的妻子的转换是而不是妻子比她们的丈夫，这可能表明，当选择丈夫退休时间的时候，家庭没有充分考虑到退休时家庭健康保险的选择。 描述证据和健康保险多项式 Logit 模型的结果转型中，包括那些在丈夫退休前就享有丈夫公司给予的保障中显示有大部分的丈夫退休后的丈夫和妻子的保障都是来自于丈夫退休前公司给予的保障。这与从健康 和退休研究会中的一个表格的横截面表明的约三分之二由雇主的赞助和自己工作的也有资格享有退休人员的福利的有着很好的对应关系。它也表明，目前大多数退休者计划为提供当前已在计划中的配偶提供保障。然而，约百分之五十的在退休后由丈夫提供保障而不是他退休就
36、过渡到另外的保险状态。几乎一半的人丢掉自己的雇主营办的健康保险在今后的一个时期里拥有医疗保险制度和有四分之一的人接受从他们的妻子雇主营办计划。这意味着一个人决定退休，有一部分是是否拥有医疗保险制度是他的驱动因素。这与工作固定和退休结构模型相一致。对妇女来说，这个是完全不 同的。因为妇女一般小于她们的丈夫，他们在丈夫退休时是没有资格得到医疗保险的。只有四分之一的妇女在丈夫退休时切换到医疗保险失去保险覆盖。增加第三个能够自己依靠自己的雇主得到保障，他们要么已经有或有能力在丧失其丈夫的保障进行选择适用范围。 虽然在雇主的支持或医疗保险计划的转型之中，不会显着增加家庭医疗保险费用，不过那些不是团体保险
37、或者没有购买保险的群体会有相当大的花费。百分之二十的已婚妇女和百分之十三的已婚男性在退休后三个月后自费购买保险之前，一直都是依赖丈夫的保险。对妇女来说，这个转型的速度是当丈夫不退休时的 两倍，而男人的大致相同。回归结果确认与丈夫相比，过渡到非集团的覆盖范围大幅比较高，否则，购买保险是转型期的最常见的当妇女失去丈夫的保障。虽然健康和退休学会没有具体询问 COBBA 采取行动，它也不会出现已购买的保障属于那个范围，由于购买的保险费率仍然很高，在未来，即使是COBBA 会被用尽。其中，已婚男性和女性，百分之十六的人以前曾经享有雇主赞助保障也变成了没有保障。比率比在非退休期间更低。因此，看来，家庭认识到降低健康保险的覆盖可以降低风险，并且在做出退休决定的时候更多的是考虑保险的覆盖范围，即使这个选择是比较 昂贵的。
