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Published in: Social Indicators Research 3/2014

01-12-2014

Assessing Health Endowment, Access and Choice Determinants: Impact on Retired Europeans’ (In)activity and Quality of Life

Authors: Luis Pina Rebelo, Nuno Sousa Pereira

Published in: Social Indicators Research | Issue 3/2014

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Abstract

A future for the E.U., dominated by an ever-increasing population of retired citizens represents a major challenge to social and health policy in European countries. Under Rowe and Kahn’s (Gerontol 37(4):433–440, 1997) perspective on positive aging, this paper is interested in exploring the role of health on citizens’ active participation after retirement and social engagement to life and quality of life. This paper also aims at finding whether Sen’s (Public health, ethics, and equity. Oxford University Press, Oxford, 2004) capability approach or cumulative disadvantage or advantage theory relative to the access to health also verifies in a context of multi-national developed economies. The first part of this study is therefore concerned with generating a health indicator that enables this, whilst controlling for individual heterogeneity in self-rated health responses from 10,859 retired individuals from the SHARE survey. Socioeconomic determinants of health are found not to be critical in determining health in such a developed context whilst cumulative advantage is found relevant for the positive aging of Europeans. Evidence is found that active engagement in activities and quality of life are most certainly a prerogative for the more educated and the healthier retirees, hinting a strategy for European policymakers: cumulative advantage, leveraged by education and health policy, might just be the long-term strategy for contouring an aging and unproductive European population, transforming what could be a ‘burden’ into an asset.

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Appendix
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Footnotes
1
Quasi-objective because we base ourselves in self-reports of disabilities objectively diagnosed by physicians.
 
2
Imputations on amount variables were conducted using the unfolding brackets and the conditional hot-deck method. Imputations on frequency variables were conducted using regression methods. Imputation minimizes bias, and uses 'expensive to collect' data, that would otherwise be discarded.
 
3
Jürges et al. (2007) showed that there are non-significant differences between the US and the E.U. scale (ranging from ‘very poor’ to ‘very good’). The two scales presented similar correlations with demographics and health indicators, and a very similar pattern of variation across countries. The authors did not find evidence that the EU version is preferable to the US version as standard measure of SRH in European countries. We ended up opting for the US scale because it exhibited a greater symmetry in responses across the 5 categories.
 
4
The estimation procedure was repeated using separate country samples. However given the large loss of sample size, results were largely insignificant. We estimated simplified versions of our model for each country (reducing it to Jurges (2007) basic model, with physical disabilities, dropping most of the significant covariates on the threshold equations), having included age and gender controls given the different country proportions. Still, even though results for the most common disabilities were similar across countries, the authors have very little confidence in the generated results. Small samples rendered low-incidence disabilities (e.g. Parkinson) largely insignificant in explaining SRH, which is fairly absurd and incoherent with the total sample results.
 
5
Though SHARE contains information that would allow a computation of a value for net worth, a good portion of individuals have negative values with origin in debt. Furthermore, the degree of reliability in an absolute exact value comprehending all net worth possessed by an individual is questionable. The best option was therefore to keep using the dichotomous variables used in the previous estimation of the Health Index.
 
6
Income was logarithmized to ease interpretation.
 
7
Cubic terms were all found insignificant. We also included a “pure” quadratic term, by centering the covariate (subtracting the mean from each of the observed individual value before squaring it). Combinations of linear and quadratic terms were found more significant, in the cases presented.
 
8
The total marginal effect at the mean is 0.4 p.p,. combining—1.7 p.p. associated to the health index linear term and 1.3 p.p.associated with the quadratic term. The 1.3 p.p. portion resulted from the derivative of the additive quadratic term in the regression function with respect to health index.
 
9
The average differential in the health index, when comparing these two types of individual health, is around 37.5 p.p.
 
10
If the marginal effect were to maintain across all the domain of the variables.
 
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Metadata
Title
Assessing Health Endowment, Access and Choice Determinants: Impact on Retired Europeans’ (In)activity and Quality of Life
Authors
Luis Pina Rebelo
Nuno Sousa Pereira
Publication date
01-12-2014
Publisher
Springer Netherlands
Published in
Social Indicators Research / Issue 3/2014
Print ISSN: 0303-8300
Electronic ISSN: 1573-0921
DOI
https://doi.org/10.1007/s11205-013-0542-1

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