This volume, from the Pension Research Council of the Wharton School, highlights many of the special health insurance problems facing the elderly and some of the solutions that any reform process must consider.

The proportion of large employers offering retiree health insurance in the U.S. has declined by half in the past 20 years. This paper examines the potential implications of this change by estimating the effects of a retiree health insurance (RHI) offer on a comprehensive set of labor, health and health care use outcomes in the near-elderly population. The analysis is based on ten years of longitudinal data from the Health and Retirement Survey (1992-2002). After restricting to respondents who have employer-sponsored health insurance at baseline, I find that an RHI offer increases the probability of early retirement by 35 percent for both men and women. An RHI offer decreases the probability of being uninsured by 55 percent, while increasing the probability of employer-sponsored coverage and decreasing the probability of public coverage. There is suggestive evidence that individuals with an RHI offer are more likely to visit the doctor, use prescription drugs on a regular basis and have outpatient surgery. While we see no significant effect on health, RHI provides significant protection from high out-of-pocket medical costs. In the top 40 percent of the out-of-pocket spending distribution, those with an offer of retiree coverage spend 21 percent less on average.Estimates of the value of RHI of over $3,000 per year suggest that increasing opportunities for the near-elderly to purchase coverage at actuarially-fair prices through the individual market or public programs could significantly increase insurance coverage and reduce financial risk for this age group.

Many U.S. workers receive health & pension benefits from employers, & the cost of these benefits represents a growing share of workers¿ total compensation. Employers have made changes to control these rising costs, contending that these changes will allow them to remain competitive in an increasingly global market. This report examines the practices employers are using to control the costs of benefits. To evaluate changing employer benefit practices & their implications, the author examined: (1) current & emerging practices employers are using to control the costs of health care benefits, & retirement benefits; & (2) employers¿ workforce restructuring changes. Charts & tables.