Medicare Growth, Technological Advances, and the Distribution of Health Care Benefits Jonathan Skinner Weiping Zhou.

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Presentation transcript:

Medicare Growth, Technological Advances, and the Distribution of Health Care Benefits Jonathan Skinner Weiping Zhou

A Simple Question Have the billions of health care dollars spent during the 1990s improved or worsened inequality in health and well- being in the elderly population?

A Not So Simple Answer Expenditures/utilization for health care: High income people get: Less (Battachyaria and Lakdawalla, 2003)) More (Le Grand, 1982; McClellan and Skinner, 2003, Sanchez et. al., 1992).

A Not So Simple Answer Improvements in Outcomes: High education / non- minority people get Less (McDermott, 1978) More ( (Glied and Lleras-Muney, 2003; Goldman and Smith, 2002; Lichtenberg and Lleras-Muney, 2002)

A Not So Simple Answer Improvements in Outcomes: High education / non- minority people get Less (McDermott, 1978) More ( (Glied and Lleras-Muney, 2003; Goldman and Smith, 2002; Lichtenberg and Lleras-Muney, 2002) How do you measure inequality in health or in full income anyway?

Our Strategy Expenditures: Fuchs proto-full income measure (Medicare expenditures plus adjusted CPS income) –Data sources: Current Medicare History Survey (CMHS), CPS

Our Strategy Expenditures: Fuchs proto-full income measure (Medicare expenditures plus adjusted CPS income) –Data sources: Current Medicare History Survey (CMHS), CPS Outcomes: CMHS Utilization: Cooperative Cardiovascular Project (CCP) data on heart attack patients (1994/95) Two measures of income: per capita family (CPS) and zip code (CMHS, CCP)

Percentage Increase in Money Income

Percentage Increase in Full Income (1): Money Income plus Medicare Expenditures,

Medicare Expenditures (Males Age 80-84) 1987 and 1997, by Income Decile Source: McClellan and Skinner, 2003

How Big is a Big Twist? Decile 10 spending increase ($3300) less Decile 1 spending increase ($1600)

How Big is a Big Twist? Decile 10 spending increase ($3300) less Decile 1 spending increase ($1600) Average EITC Payments per family receiving EITC (1997) Source: Brookings-Urban Website

Average Home Health Care Spending By Decile : Men Age in $ Lowest Income Decile Highest Income Decile

Home Health Care Expenditures 1996 by Region

Next Measure: Changes over time in Income Including Lifespan

How Does One Place a Dollar Value on Lifespan Extension? Approach number 1: value gains in life-years for low income households by more (Cost-Benefit Analysis) Approach number 2: Value gains in life-years for low income households by less (Becker et. al. “WTP”)

10-Year Survival Rates Rose in Highest Income Deciles by More than in Lowest Income Deciles

Percentage Increase in Full Income (2): Money Income plus Value of Life Extension,

A Third Approach: Focus on Utilization of “Effective” Technological Innovations

Causes of 90-Day AMI Mortality Decline, Source: Heidenrich and McClellan, 2001 No Significant Impact: CABG, calcium antagonists, PTCA (non-primary), nitrates, anticoagulants, etc.

Effective Care Following AMI: By Zip Code Income Beta Blocker ACE Inhibitor Reper- fusion Smoking Cessation Advice Decile Decile Difference 7252

Percent of “Ideal” Patients Receiving Beta Blockers at Discharge Following AMI ( ) Beta Blocker Use By Region Source: Dartmouth Atlas

Income per Capita in 2000 and Average 1-Year AMI Mortality ( ) by State

Putnam’s Social Capital Index and Average 1-Year Mortality ( ) by State

Medicare Expenditures (Age M) by Year ( or ) Decile 1 in 1992 Decile 10 in 1992 Decile 1,10 in 1982