Evaluating Health Care Reform Using the Healt and Retirement Survey: A Case Study of the Health Security Act of 1993

by Dana P. Goldman, Paul Gertler, James P. Smith


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Health care reform could dramatically alter the health care landscape. While there is substantial disagreement over the changes that should be implemented, there appears to be a consensus within the Federal Government that insurance markets need reform. To forecast the likely effects of reform, it is necessary to construct models of consumer behavior. The new Health and Retirement Survey (HRS), because of its thorough data elements and longitudinal sampling frame, is uniquely suited to answer the key behavioral questions associated with health care form. This paper describes how the HRS can be used to forecast some of the likely behavioral responses of mature Americans (aged 51 to 61) to the Health Security Act of 1993 (HSA) and as a benchmark to evaluate the impact of any health care reform. The authors draw attention to the 1992 round of the HRS as a tool for analyzing the likely impact of HSA on insurance choice, health care utilization, health outcomes, family labor supply and retirement, wealth, intergenerational transfers and living arrangements. They discuss how future waves of the HRS could be used to explain the dynamic relationships between deteriorating health, asset decumulation, and employment as individuals move further along the life-cycle.

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