Population Aging and Healthcare: The Case of Underserved Older Populations
Population aging poses significant challenges for healthcare systems worldwide. Disadvantaged populations often encounter substantial barriers to accessing healthcare, leading to poorer health outcomes in later life. Despite these challenges, relatively little research has explored the mechanisms through which protective factors can mitigate health disparities among underserved populations.
As societies continue to age, understanding the complex relationships among aging, health, and population-specific characteristics is increasingly important for policymakers seeking to allocate limited healthcare resources efficiently and equitably. Hankyung Jun, DPI Program Advisor and a Senior Research Scientist at NYU Stern School of Business, examines how public policies and socioeconomic factors influence health outcomes among underserved older adults, with particular emphasis on older immigrants, nursing home residents, and individuals living with Alzheimer's disease.
Mental Health in Nursing Homes: The Role of Immigration in the Long-Term Care Workforce
Hankyung Jun, David C. Grabowski
(Harvard Medical School)
Social Science & Medicine, 2024
One-fourth of nursing home residents are diagnosed with anxiety disorders and approximately half live with depression. Nursing homes have long struggled with staffing shortages, and the lack of care has further heightened the risk of poor mental health. A key solution to both problems could be immigration. Prior studies have documented how immigrant labor could strengthen the long-term care workforce. We add to this picture by exploring the impact of immigrant inflows on the mental health outcomes of nursing home residents. Using a nationally representative dataset and a shift-share instrumental variable approach, we find empirical evidence that immigration reduces diagnoses of depression and anxiety, the use of antidepressant and antianxiety drugs, and self-assessed symptoms of depression. The results are robust to several sensitivity tests. We further find that the effect is more substantial in facilities with lower direct care staff hours per resident and with likely more immigrants without citizenship. Language barriers tend to be a minor issue when providing essential care. The findings suggest that creating a policy framework that directs immigrant labor to the long-term care sector can mutually benefit job-seeking immigrants and nursing home residents.
The Value of Medicare Coverage on Depressive Symptoms Among Older Immigrants
Hankyung Jun, Soeren Mattke, Alice Chen, and Emma Aguila
The Gerontologist, 2023
Abstract
Background and Objectives: The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the United States.
Research Design and Methods: Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity.
Results: Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants—Black, Hispanic, and Asian/Pacific Islander—even when holding socioeconomic status constant.
Discussion and Implications: Our findings imply that immigration policies that expand health care protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.
Keywords: Depression, Disparities, Health insurance
Is Korea Prepared for an Alzheimer’s Disease-Modifying Therapy? Assessing the Korean Healthcare System Infrastructure and the Effect of Blood-Based Biomarker Tests
Hankyung Jun, Sang Kyu Cho, Joanne Yoong, Soeren Mattke
Annals of Geriatic Medicine and Research, 2021
Background: With the rapid demographic change in Korea, Alzheimer’s disease has become a primary concern. Recent developments in disease-modifying therapies provide hope that therapy may become available soon. The high disease prevalence and complex evaluation process will create challenges for the healthcare system already burdened by the current pandemic. This study examined the preparedness of the South Korean healthcare system to identify and treat patients when such a therapy becomes available.
Methods: We used a Markov model to simulate a stylized patient’s journey. Based on national data and expert input, we presented projections of the diagnosis and treatment wait times and respective queues of patients under treatment and no-treatment scenarios and further simulated the possible option of adopting a blood-based biomarker test.
Results: Under the current system, we estimated a peak waiting time of 14 months when a treatment became available, largely because of the limited number of dementia specialists. Adopting a blood-based biomarker test dramatically reduced the initial wait times by more than half. A disease-modifying therapy was estimated to avert 575,000 incident cases in the first 10 years after the treatment entered the market, and a blood-based test further avoided 86,000 additional cases.
Conclusion: South Korea’s healthcare infrastructure requires more preparation for the introduction of a disease-modifying therapy, with the primary capacity limitation being the low number of dementia specialists. The utilization of a blood-based test for Alzheimer’s disease biomarkers may be an effective solution.
Key Words: Alzheimer’s disease, Cognitive Dysfunction, Biomarkers, Republic of Korea
Social security and retirement in fast-aging middle-income countries: Evidence from Korea
Hankyung Jun
Journal of the Economics of Ageing, 2020
Many middle-income countries have been witnessing rapid population aging, increasing pressures on their relatively fragile public pensions. Older workers may want to delay retirement to finance their prolonged lives, but job markets are not favorable for them. A hike in pension benefits might increase individual financial security, but weaken pension stability. Using panel data for older workers in Korea – a typical fast-aging middle income country with a high rate of elderly poverty – this study finds that the forward-looking incentive measures associated with the public pension have a statistically significant effect on retirement probability. Older wage workers are more responsive to utility gains from continued work due to additional earnings and increased pension benefits than to financial gains from greater pension wealth. The significant effect of transfers from children to parents at retirement is particularly noteworthy, suggesting low fertility rates have made more difficult the tasks of alleviating elderly poverty and maintaining pension stability.
Population Aging and Healthcare: The Case of Underserved Older Populations
Population aging poses significant challenges for healthcare systems worldwide. Disadvantaged populations often encounter substantial barriers to accessing healthcare, leading to poorer health outcomes in later life. Despite these challenges, relatively little research has explored the mechanisms through which protective factors can mitigate health disparities among underserved populations.
As societies continue to age, understanding the complex relationships among aging, health, and population-specific characteristics is increasingly important for policymakers seeking to allocate limited healthcare resources efficiently and equitably. Hankyung Jun, DPI Program Advisor and a Senior Research Scientist at NYU Stern School of Business, examines how public policies and socioeconomic factors influence health outcomes among underserved older adults, with particular emphasis on older immigrants, nursing home residents, and individuals living with Alzheimer's disease.
Mental Health in Nursing Homes: The Role of Immigration in the Long-Term Care Workforce
Hankyung Jun, David C. Grabowski
(Harvard Medical School)
Social Science & Medicine, 2024
One-fourth of nursing home residents are diagnosed with anxiety disorders and approximately half live with depression. Nursing homes have long struggled with staffing shortages, and the lack of care has further heightened the risk of poor mental health. A key solution to both problems could be immigration. Prior studies have documented how immigrant labor could strengthen the long-term care workforce. We add to this picture by exploring the impact of immigrant inflows on the mental health outcomes of nursing home residents. Using a nationally representative dataset and a shift-share instrumental variable approach, we find empirical evidence that immigration reduces diagnoses of depression and anxiety, the use of antidepressant and antianxiety drugs, and self-assessed symptoms of depression. The results are robust to several sensitivity tests. We further find that the effect is more substantial in facilities with lower direct care staff hours per resident and with likely more immigrants without citizenship. Language barriers tend to be a minor issue when providing essential care. The findings suggest that creating a policy framework that directs immigrant labor to the long-term care sector can mutually benefit job-seeking immigrants and nursing home residents.
The Value of Medicare Coverage on Depressive Symptoms Among Older Immigrants
Hankyung Jun, Soeren Mattke, Alice Chen, and Emma Aguila
The Gerontologist, 2023
Abstract
Background and Objectives: The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the United States.
Research Design and Methods: Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity.
Results: Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants—Black, Hispanic, and Asian/Pacific Islander—even when holding socioeconomic status constant.
Discussion and Implications: Our findings imply that immigration policies that expand health care protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.
Keywords: Depression, Disparities, Health insurance
Is Korea Prepared for an Alzheimer’s Disease-Modifying Therapy? Assessing the Korean Healthcare System Infrastructure and the Effect of Blood-Based Biomarker Tests
Hankyung Jun, Sang Kyu Cho, Joanne Yoong, Soeren Mattke
Annals of Geriatic Medicine and Research, 2021
Background: With the rapid demographic change in Korea, Alzheimer’s disease has become a primary concern. Recent developments in disease-modifying therapies provide hope that therapy may become available soon. The high disease prevalence and complex evaluation process will create challenges for the healthcare system already burdened by the current pandemic. This study examined the preparedness of the South Korean healthcare system to identify and treat patients when such a therapy becomes available.
Methods: We used a Markov model to simulate a stylized patient’s journey. Based on national data and expert input, we presented projections of the diagnosis and treatment wait times and respective queues of patients under treatment and no-treatment scenarios and further simulated the possible option of adopting a blood-based biomarker test.
Results: Under the current system, we estimated a peak waiting time of 14 months when a treatment became available, largely because of the limited number of dementia specialists. Adopting a blood-based biomarker test dramatically reduced the initial wait times by more than half. A disease-modifying therapy was estimated to avert 575,000 incident cases in the first 10 years after the treatment entered the market, and a blood-based test further avoided 86,000 additional cases.
Conclusion: South Korea’s healthcare infrastructure requires more preparation for the introduction of a disease-modifying therapy, with the primary capacity limitation being the low number of dementia specialists. The utilization of a blood-based test for Alzheimer’s disease biomarkers may be an effective solution.
Key Words: Alzheimer’s disease, Cognitive Dysfunction, Biomarkers, Republic of Korea
Social security and retirement in fast-aging middle-income countries: Evidence from Korea
Hankyung Jun
Journal of the Economics of Ageing, 2020
Many middle-income countries have been witnessing rapid population aging, increasing pressures on their relatively fragile public pensions. Older workers may want to delay retirement to finance their prolonged lives, but job markets are not favorable for them. A hike in pension benefits might increase individual financial security, but weaken pension stability. Using panel data for older workers in Korea – a typical fast-aging middle income country with a high rate of elderly poverty – this study finds that the forward-looking incentive measures associated with the public pension have a statistically significant effect on retirement probability. Older wage workers are more responsive to utility gains from continued work due to additional earnings and increased pension benefits than to financial gains from greater pension wealth. The significant effect of transfers from children to parents at retirement is particularly noteworthy, suggesting low fertility rates have made more difficult the tasks of alleviating elderly poverty and maintaining pension stability.