Academic journal article NBER Reporter

Health Care. (Conferences)

Academic journal article NBER Reporter

Health Care. (Conferences)

Article excerpt

The NBER's Program on Health Care met in Cambridge on November 1. Alan M. Garber, NBER and Stanford University, organized the meeting, at which these papers were discussed:

Sherry A. Glied, NBER and Columbia University, and Adriana Lleras-Muney, NBER and Princeton University, "Health Inequality, Education, and Medical Innovation"

Dana Goldman, Rand Corporation, and Darius Lakdawalla, NBER and Rand Corporation, "Health Disparities and Medical Technology"

Janet Currie, NBER and University of California, Los Angeles, and Mark Stabile, NBER and University of Toronto, "Socioeconomic Status and Health: Why is the Relationship Stronger for Older Children?"

Kate Bundorf, NBER and Standford University, "The Effects of Offering Health Plan Choice within Employment-Based Purchasing Groups"

Michael Chernew, NBER and University of Michigan; David M. Cutler, NBER and Harvard University; and Patricia Keenan, Harvard University, "Rising Health Care Cost and the Decline in Health Insurance Coverage"

Recent studies suggest that health inequalities across socioeconomic groups in the United States are large and have been growing. Glied and Lleras-Muney hypothesize that, as in other non-health contexts, this pattern occurs because more educated people benefit more than do the less educated from technological advances in medicine. They test this hypothesis by examining the evolution of mortality differentials and medical innovation over time. Glied and Lleras-Muney focus on cancer mortality and examine the incidence of cancer and survival rates conditional on disease incidence. Although there have not been great improvements in cancer survival overall, there has been substantial progress in the treatment of some forms of cancer. Glied and Lleras-Muney find that more educated people are better able to take advantage of new medical innovations.

Although better-educated people are healthier, the relationship between health and education varies substantially across groups and over time. Goldman and Lakdawalla ask how health disparities by education vary according to underlying health characteristics and market forces. Consumer theory suggests that improvements in the productivity of health care will tend to confer the most benefits upon the heaviest users of health care. Since richer and more educated patients tend to use the most health care, this suggests that new technologies -- by making more diseases treatable, reducing the price of health care, or improving its productivity -- will tend to widen disparities in health. On the other hand, by the same reasoning, new technologies that are "timesaving" can lessen health disparities if they lower the productivity of patients' time investments in health. These ideas explain several empirical patterns. First, compared to healthy people, the chronically ill exhibit wider disparities in health status, but the terminally ill exhibit narrower ones. Second, the advent of complex new HIV technologies increased immune function among HIV patients, but seemed to benefit educated patients disproportionately. In contrast, however, new drugs for hypertension lowered health inequality, by making investments in diet, exercise, and weight control much less important for hypertension control.

The well-known relationship between socioeconomic status (SES) and health exists in childhood and grows more pronounced with age. However, it is difficult to distinguish between two possible explanations of this. Are low-SES children less able to respond to a given health shock? Or, do low SES children experience more shocks? Using panel data on Canadian children, Currie and Stabile show that: 1) the cross-sectional relationship between low family income or low maternal education and health is very similar in Canada and the United States; and 2) both high and low-SES children recover from past health shocks to about the same degree. …

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