Thomas DeLeire

The Wage and Employment Effects of the Americans with Disabilities Act

The Americans with Disabilities Act of 1990 (ADA) is analyzed in terms of its effects on the employment and wages of disabled men using data from the Survey of Income and Program Participation. The results indicate that, as early as 1990, employment rates of men with disabilities decreased dramatically and continued to decrease through the beginning of 1995. On average over the post-ADA period, employment of men with disabilities was 7.2 percentage points lower than before the act was passed. In addition, wages of disabled men did not change with the passage of the ADA.

The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres

BACKGROUND This study aimed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres. METHODS A prospective, multi-centre, questionnaire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries. The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008. The main outcome measures were health care costs, costs of productivity loss, total costs and quality-adjusted life years. Predictors of costs were identified using regression analysis. RESULTS Data analysis of 909 women demonstrated that the average annual total cost per woman was €9579 (95% confidence interval €8559-€10 599). Costs of productivity loss of €6298 per woman were double the health care costs of €3113 per woman. Health care costs were mainly due to surgery (29%), monitoring tests (19%) and hospitalization (18%) and physician visits (16%). Endometriosis-associated symptoms generated 0.809 quality-adjusted life years per woman. Decreased quality of life was the most important predictor of direct health care and total costs. Costs were greater with increasing severity of endometriosis, presence of pelvic pain, presence of infertility and a higher number of years since diagnosis. CONCLUSIONS Our study invited women to report resource use based on endometriosis-associated symptoms only, rather than drawing on a control population of women without endometriosis. Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases (diabetes, Crohns disease, rheumatoid arthritis). It arises predominantly from productivity loss, and is predicted by decreased quality of life.

Good Things Come in Threes: Single-Parent Multigenerational Family Structure and Adolescent Adjustment

Using data from the National Educational Longitudinal Study (NELS), we found that teenagers who live in nonmarried families are less likely to graduate from high school or to attend college, more likely to smoke or drink, and more likely to initiate sexual activity. Not all nonmarried families are alike, however. In particular, teenagers living with their single mothers and with at least one grandparent in multigenerational households have developmental outcomes that are at least as good and often better than the outcomes of teenagers in married families. These findings obtain when a wide array of economic resources, parenting behavior, and home and school characteristics are controlled for.

An Economic Model of Locus of Control and the Human Capital Investment Decision

We present an economic model of how teenagers’ outlooks—specifically their locus of control—affect their human capital investments. Locus of control measures the extent to which a person believes their actions affect their outcomes. The model allows locus of control to affect teenagers’ assessment of the return to education. The effect of eighth graders’ locus of control on high school completion and college attendance is examined using the National Educational Longitudinal Study. The results indicate that locus of control influences education decisions and suggests that locus of control operates through teenagers’ expectations of the returns to human capital investments.

Worker Sorting and the Risk of Death on the Job

This article examines worker sorting across occupations in response to the risk of death on the job. We use family structure as a proxy for willingness to trade safety for wages to test the proposition that workers with strong aversion to this risk sort into safer jobs. We estimate conditional logit models of occupation choice as a function of injury risk and other job attributes. Our results confirm the sorting hypothesis: within gender, single moms and dads are the most averse to risk. Overall, differences in the risk of death across occupations explain about one‐quarter of occupational gender segregation.

Changes in Wage Discrimination against People with Disabilities: 1984-93

The extent to which discrimination against people with disabilities has changed from 1984 to 1993 is estimated in this paper. A novel data source—a set of health-impaired workers who self-report that their productivity is not affected by their impairment—is used to separately identify the effects of discrimination on wages from those of poor health. The results indicate that for this group in 1984 only 3.7 percentage points of the earnings gap can be attributed to discrimination. Assuming that work limited people with disabilities face an identical amount of discrimination allows one to separately identify the effects of health from the effects of wage discrimination on the earnings of people with disabilities and implies that the effects of discrimination are small. Moreover, the analysis indicates that the amount of discrimination did not decrease by 1993, despite the passage of the Americans with Disabilities Act of 1990 (ADA). While discrimination did not change over this period, the negative effects of poor health on the earnings of people with disabilities fell substantially; this suggests that without either improvements in technology or the accommodation provisions of the ADA, the earnings gaps faced by people with disabilities would have been even higher in 1993.

Polarization and rising wage inequality : comparing the U.S. and Germany

This paper compares trends in wage inequality in the U.S. and Germany using an approach developed by MaCurdy and Mroz (1995) to separate age, time, and cohort effects. Between 1979 and 2004, wage inequality increased strongly in both the U.S. and Germany but there were various country specific aspects of this increase. For the U.S., we find faster wage growth since the 1990s at the top (80% quantile) and the bottom (20% quantile) compared to the median of the wage distribution, which is evidence for polarization in the U.S. labor market. In contrast, we find little evidence for wage polarization in Germany. Moreover, we see a large role played by cohort effects in Germany, while we find only small cohort effects in the U.S. Employment trends in both countries are consistent with polarization since the 1990s. We conclude that although there is evidence in both the U.S. and Germany which is consistent with a technology-driven polarization of the labor market, the patterns of trends in wage inequality differ strongly enough that technology effects alone cannot explain the empirical findings.

Wisconsin Experience Indicates That Expanding Public Insurance To Low-Income Childless Adults Has Health Care Impacts

As states consider expanding Medicaid to low-income childless adults under the Affordable Care Act, their decisions will depend, in part, on how such coverage may affect the use of medical care. In 2009 Wisconsin created a new public insurance program for low-income uninsured childless adults. We analyzed administrative claims data spanning 2008 and 2009 using a case-crossover study design on a population of 9,619 Wisconsin residents with very low incomes who were automatically enrolled in this program in January 2009. In the twelve months following enrollment in public insurance, outpatient visits for the study population increased 29 percent, and emergency department visits increased 46 percent. Inpatient hospitalizations declined 59 percent, and preventable hospitalizations fell 48 percent. These results demonstrate that public insurance coverage expansions to childless adults have the potential to improve health and reduce costs by increasing access to outpatient care and reducing hospitalizations.

The prevalence and determinants of antepartum mental health problems among women in the USA: a nationally representative population-based study

Mental health problems disproportionately affect women, particularly during childbearing years. We sought to estimate the prevalence of antepartum mental health problems and determine potential risk factors in a representative USA population. We examined data on 3,051 pregnant women from 11 panels of the 1996–2006 Medical Expenditure Panel Survey. Poor antepartum mental health was defined by self report of mental health conditions or symptoms or a mental health rating of “fair” or “poor.” Multivariate regression analyses modeled the odds of poor antepartum mental health; 7.8% of women reported poor antepartum mental health. A history of mental health problems increased the odds of poor antepartum mental health by a factor of 8.45 (95% CI, 6.01–11.88). Multivariate analyses were stratified by history of mental health problems. Significant factors among both groups included never being married and self-reported fair/poor health status. This study identifies key risk factors associated with antepartum mental health problems in a nationally representative sample of pregnant women. Women with low social support, in poor health, or with a history of poor mental health are at an increased risk of having antepartum mental health problems. Understanding these risk factors is critical to improve the long-term health of women and their children.

Is Welfare Reform Responsible for Low-Skilled Women's Declining Health Insurance Coverage in the 1990s?

We use data from the 1989–2001 March Supplements to the Current Population Survey to determine whether welfare reform contributed to declines in health insurance coverage experienced by low-skilled women. Between 1988 and 2000, women with less than a high school education experienced an 8.0 percentage point decline in the probability of having health insurance. Against this backdrop of large declines, welfare waivers and TANF are associated with modest increases in coverage for low-skilled women of 2.3 and 3.6 percentage points respectively. Overall, our findings suggest that welfare reform did not contribute to declines in coverage but rather offset them somewhat.