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Do Health Shocks Increase Retirement More When Workers are Universally Insured

Rationale: Health shocks significantly alter workers' retirement plans, more so than a worsening in a already existing health condition. Dwyer and Hu (2000) find that developing a new work limitation between 2 waves of the U.S. HRS increases the likelihood of retirement more than having a persistent limitation. Coile (2004) finds that the shock effect of an unexpected health event such as a heart attack or the onset of a new chronic condition leads to a serious financial loss for the family. The labour supply response following a health shock, however, would depend on having access to pensions and health insurance. Within an employment-contingent health insurance system without retiree health insurance, workers may be forced to continue working simply to be able to pay the costs of their medical treatment, see for example Bradley al. (2005). When workers are universally insured, insurance is not contingent on employment. Therefore, we would expect that health shocks would increase retirement to a larger extent in a general tax-financed health-care system with universal access such as the Danish one, compared to the US. 
Objectives: Our aim is to compare the retirement effects of negative health shocks occuring in a universally insured health care system to those found in similar US sub-samples, both with and without insurance coverage, for narrowly defined health conditons. 
Methodology: We explore our question by estimating pooled and random effects probability of work-for-pay models. In these models, we compare the effect of new acute condition of new chronic disease on the probability of working for pay on sub-samples of workers aged 51-64 in the Danish Longitudinal Registers, 1991-2001, and similarly defined sub-samples drawn from the US HRS, 1992-2002. 
Results: Our results show that while new chronic conditions lead individuals to reduce work at about the same rate in both countries, older Americans are three times as likely to stop working for pay following an acute condition than similar Danes. Accounting for insurance differences narrows this gap by almost two-thirds for single women who suffer an acute shock and lack retiree insurance but do not affect the findings for any other group. Thus, insurance differences cannot explain this puzzling gap which persists even after accounting for unobserved heterogeneity and justification bias in self-assessed health and which, furthermore, is robust to different checks. 
Conclusions: One plausible explanation for the observed country difference is that older Danes could be in better general health than their American counterparts and therefore less debilitated by the impact of a health shock. Another explanation could be that getting a new job may be easier for older workers in the US. On the fact of it, there seems to be little evidence to suggest that a universally-insured health-care system like the Danish one leads to excessive retirement following a health shock, although there may be hidden selection in that Danes may tend to retire at the first sign of a health problem, before a health shock can occur.