Disability Reporting Choices by Married Couples: Evidence from Census Data.

• Author: Zimmer, Michael

Michael Zimmer [*]

The purpose of this paper is to analyze determinants of the decision to self-report health impairments that limit or prevent work. Its particular focus is on joint reporting behavior by married couples, with a view toward potential interdependence of spouses' reporting decisions. The model is based on a large sample of married couples taken from the 1990 Public Use Microdata Sample of the U.S. Census. Empirical analysis is based on a simultaneous probit model of spouses' reports. Results of the analysis show evidence of an association between spouses reports, after controlling for important background variables. The extent of association appears to be more pronounced among low earners and among older wives.

1. Introduction

   During the past two decades, the United States has witnessed a marked increase in persons seeking and receiving public assistance for physical impairments and work disabilities. Income support programs remain a significant component of national policy toward the disabled. The Social Security Disability Insurance program (DI) provides benefits to disabled persons based on payroll tax contributions during their working years, and the Supplemental Security Income (SSI) program is means-tested and not linked to prior payroll contributions. By 1995, annual SSI payments had grown to $19.5 billion for 4.9 million recipients, and DI paid $40.0 billion to 4.2 million recipients (Rupp and Stapleton 1998, p. 2).

   These programs, together with changes accompanying the Americans with Disabilities Act (ADA) in 1990, have engendered considerable research regarding their behavioral consequences within the disabled population. A principal item of interest has been consequences of public policy for supply of labor by disabled persons and demand for their services by employers (Burkhauser and Haveman 1982; Leonard 1991; Rosen 1991; Stern 1989). Other studies have investigated the effects of health impairments on workers' earnings (Baldwin, Zeager, and Flacco 1994; Kahn 1998).

   The motivation for this paper is that most previous research has left unexplored the question of behavior regarding reporting of disabilities. The importance of this issue arises from the fact that self-reports of disabilities constitute the substance of available data on the impaired population. Agencies such as the Census Bureau and the Social Security Administration rely on individual or household data in which persons describe the existence and degree of their physical limitations. Moreover, claims to payments under DI or SSI are initiated by persons who self-report their impairments and then submit claims for clinical evaluation as the basis of application for benefits.

   In view of the importance of self-reporting behavior, there appears to have been relatively little attention paid to its determinants. Exceptions include Chirikos and Nestel (1984) and Aarts and deJong (1992). The purpose of this paper is to analyze determinants of the decision to self-report physical impairments that limit or prevent work. Its particular focus is on reporting behavior of married couples, with a view toward the potential interdependence of spouses' reporting decisions. Interdependence is important for policy purposes, because it could produce a tendency toward clustering of reported disabilities within the married population. The model is based on a large sample of intact marriages taken from the 1990 Public Use Microdata Sample (PUMS) of the U.S. Census. Results of the model indicate a positive association between spouses' reports, after controlling for important background factors.

   The remainder of the paper is organized as follows. Sections 2 and 3 provide a background of previous studies that motivate the work described here. Section 4 describes a statistical framework in which the potential for mutual dependence between spouses can be inferred. Section 5 describes the data and model specification while section 6 presents results of estimation. The final section summarizes principal findings.

2. Descriptive Evidence and Policy Implications

   A substantial amount of our knowledge about the disabled population comes from information that individuals report about themselves to the Census Bureau and the Social Security Administration. Rosen (1991, pp. 19-20) reports that in both 1970 and 1980, approximately 13% of people aged 15 and older reported themselves as disabled. Census data contain some hints of matching behavior between spouses. The 1990 PUMS records used in this study, described in more detail in section 5, include responses to questions about health status for each individual and his or her spouse. Respondents indicated whether they had a physical condition that limited their work and whether they were prevented from working by those limitations. The responses are cross-tabulated for a large sample of husband-wife pairs in Table 1. Entries in the tables are sample proportions corresponding to each possible combination of spouses' responses.

   The proportions are not remarkable at first glance, revealing that most couples report no disabilities and the least frequent occurrence is for both spouses reporting disabilities. However, the distribution is apparently not consistent with what would have been obtained if disability status were an independent phenomenon between spouses; in each case, chi-square statistics based on the absolute frequencies in each cell are sufficiently large to reject the null hypothesis of independence. Some perspective of the extent of interdependence can be gained by assessing conditional probabilities embodied in Table 1. The probability that a randomly selected husband reports a work-limiting disability is .13; if his wife reports a similar disability, however, his probability increases to .41. For wives, the probability of a work-limiting disability is .10, but it increases to .31 if the husband reports likewise. For work-preventing disabilities, the pattern is similar: The husband's probability is .08 but increases to .38 conditional on a disabled wife, and the wife's probability is .06 while increasing to .32 if the husband is disabled.

   An understanding of spouses' joint reporting behaviors is important for future policy considerations. Previous studies have established that self-reports of health problems are associated with reductions in labor force participation (Bound and Waidman 1992) and that families' predominant strategies for coping with loss of income due to disability include application for income assistance (Johnson and Murphy 1975). The implication is that the same factors that lead families to report ill health or physical impairments induce a demand for disability benefits. Researchers have noted this connection in past studies of growth in the DI and SSI programs. Stapleton et al. (1988), analyzing the programs' growth from 1988 to 1992, conclude that expansion of the disability population arose from four causes. First, the recession of 1990-1991 expanded the ranks of unemployed, some of whom sought and received disability benefits. Second, reductions at the federal level in general welfare assistance indirectly caused indi viduals to seek alternative forms of income support, namely disability benefits. Third, an increase in the population of children from single-parent families lead to extension of benefits to disabled children. Finally, an increase in the supply of applicants occurred in response to expansion in the scope and generosity of benefits. Bound and Waidman (1992) corroborate the latter point, citing policy changes that more readily accommodated disability applicants.

   Another factor in the programs' growth, which has not received attention in previous research, is the potential clustering of reported disability within families. As Yelowitz (1998, p. 126) suggests, once a household enrolls one member in an income support program, its propensity to enroll others might increase. Some researchers have noted that spouses of disabled persons have a higher tendency to report themselves as disabled. Johnson and Murphy (1975, pp. 89-90) observed such a tendency in the 1966 Social Security Survey of the Disabled. Kennedy, Walls, and Owens-Nicholson (1999, pp. 47-49), using the 1992-93 Surveys of Income and Program Participation, find that spouses of disabled persons are the primary source of caregiving assistance, and caregivers themselves tend to self-report higher rates of disability. LaPlante et al. (1996), using data from the 1990 National Health Interview Survey, report a result similar to that in Table 1: The number of households in which both partners report disabilities exc eeds what one would expect by chance if partners' disabilities were not correlated.

   These papers present the spousal connection only in a descriptive sense and do not provide a structural explanation. The purpose of this paper is to determine whether an association exists between spouses' self-reports after controlling for important background variables and whether the clustering phenomenon appears to be uniform across broadly defined age and income groups. The descriptive sample proportions in Table 1 are not useful for that purpose, because they do not control for background variables. Consequently, they are not informative about spouses' interdependence in reporting behavior per se. For example, it is well known that individuals tend to marry persons similar in age to themselves, and physical impairments are more likely to occur as individuals (hence, marriages) advance in years. Sociologists have also noted a tendency for positive assortative mating with respect to education (Mare 1991), which in turn appears to be related to the incidence of reported disabilities (Berkowitz and Hill 19 89). Consequently, observed patterns of assortative mating might be an artifact of association in age and education that characterizes most marriages. The critical question is whether spouses'...