Meghan Skira

The effect of informal care on work and wages.

Cross-sectional evidence in the United States finds that informal caregivers have less attachment to the labor force. The causal mechanism is unclear: do children who work less become informal caregivers, or are children who become caregivers working less? Using longitudinal data from the Health and Retirement Study, we identify the relationship between informal care and work in the United States, both on the intensive and extensive margins, and examine wage effects. We control for time-invariant individual heterogeneity; rule out or control for endogeneity; examine effects for men and women separately; and analyze heterogeneous effects by task and intensity. We find modest decreases-2.4 percentage points-in the likelihood of working for male caregivers providing personal care. Female chore caregivers, meanwhile, are more likely to be retired. For female care providers who remain working, we find evidence that they decrease work by 3-10hours per week and face a 3 percent lower wage than non-caregivers. We find little effect of caregiving on working mens hours or wages. These estimates suggest that the opportunity costs to informal care providers are important to consider when making policy recommendations about the design and funding of public long-term care programs.

Dynamic wage and employment effects of elder parent care

This article formulates and estimates a dynamic discrete choice model of elder parent care and work to analyze how caregiving affects a womans current and future labor force participation and wages. The model incorporates parental health changes, human capital accumulation, and job offer availability. The estimates indicate that women face low probabilities of returning to work or increasing work hours after a caregiving spell. I use the estimated model to simulate the caregiving, employment, and welfare effects of a longer unpaid work leave than currently available under the Family and Medical Leave Act, a paid leave, and a caregiver allowance.

An Evaluation of Performance Thresholds in Nursing Home Pay‐for‐Performance

OBJECTIVE Performance thresholds are commonly used in pay-for-performance (P4P) incentives, where providers receive a bonus payment for achieving a prespecified target threshold but may produce discontinuous incentives, with providers just below the threshold having the strongest incentive to improve and providers either far below or above the threshold having little incentive. We investigate the effect of performance thresholds on provider response in the setting of nursing home P4P. DATA SOURCES The Minimum Data Set (MDS) and Online Survey, Certification, and Reporting (OSCAR) datasets. STUDY SETTING AND DESIGN Difference-in-differences design to test for changes in nursing home performance in three states that implemented threshold-based P4P (Colorado, Georgia, and Oklahoma) versus three comparator states (Arizona, Tennessee, and Arkansas) between 2006 and 2009. PRINCIPAL FINDINGS We find that those farthest below the threshold (i.e., the worst-performing nursing homes) had the largest improvements under threshold-based P4P while those farthest above the threshold worsened. This effect did not vary with the percentage of Medicaid residents in a nursing home. CONCLUSIONS Threshold-based P4P may provide perverse incentives for nursing homes above the performance threshold, but we do not find evidence to support concerns about the effects of performance thresholds on low-performing nursing homes.

Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs

Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health-care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement.

A Comprehensive Measure of the Costs of Caring for a Parent: Differences According to Functional Status: Costs of Informal Care

Approximately 34 million family and friends provided unpaid care to individuals aged 50 and older in 2015. It is difficult to place a value on that time, because no payment is made to the caregiver, and multiplying caregiving hours by a wage does not account for the value of lost leisure time, implications for future employability and wages, or any intrinsic benefits accrued to the care provider. This study used a dynamic discrete choice model to estimate the costs of informal care provided by a daughter to her mother, including these other costs and benefits not typically accounted for, and compared these cost estimates for 4 categories of the mothers functional status: doctor‐diagnosed memory‐related disease, limitations in activities of daily living (ADLs), combination of both, cannot be left alone for 1 hour or more. We studied women aged 40 to 70 with a living mother at the start of the sample period (N=3,427 adult daughters) using data from the Health and Retirement Study (1998–2012). The primary outcome was the monetized change in well‐being due to caregiving, what economists call “welfare costs.” We estimate that the median cost to the daughters well‐being of providing care to an elderly mother ranged from

SINGLE MOMS AND DEADBEAT DADS: THE ROLE OF EARNINGS, MARRIAGE MARKET CONDITIONS, AND PREFERENCE HETEROGENEITY: SINGLE MOMS AND DEADBEAT DADS

144,302 to

Missing work is a pain: the effect of Cox-2 inhibitors on sickness absence and disability pension receipt

201,896 over 2 years, depending on the mothers functional status. These estimates suggest that informal care cost

Long-term care insurance: Does experience matter?

277 billion in 2011, 20% more than estimates that account only for current foregone wages.

Effect of Informal Care on Work, Wages, and Wealth

Why do some men father children outside of marriage without providing support? Why do some women have children outside of marriage when they receive little support from fathers? Why is this behavior more common among Blacks than Whites? We estimate a dynamic equilibrium model of marriage, employment, fertility, and child support decisions. We consider the extent to which low earnings, marriage market conditions, and preference heterogeneity explain nonmarital childbearing, deadbeat fatherhood, and racial differences in these outcomes. We find the Black–White earnings gap and preference heterogeneity explain a substantial portion of racial differences, whereas marriage market conditions are less important.

Do Couples Self-Insure? The Effect of Informal Care on a Couple's Labor Supply

How does medical innovation affect labor supply? We analyze how the availability of Cox-2 inhibitors, pharmaceuticals used for treating pain and inflammation, affected the sickness absence and disability pension receipt of individuals with joint pain. We exploit the market entry of the Cox-2 inhibitor Vioxx and its sudden market withdrawal as exogenous sources of variation in drug use. Using Norwegian administrative data, we find Vioxx’s entry decreased quarterly sickness absence days among individuals with joint pain by 7–12 percent. The withdrawal increased sickness days by 12–16 percent and increased the quarterly probability of receiving disability benefits by 6–15 percent.