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Health Returns to Medical Expenditures and Medical Expenditure Components across Age Groups.

机译：跨年龄段的医疗支出和医疗支出构成的健康回报。

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摘要

Medical expenditures as a percentage of GDP have doubled during the past three decades, reflecting technology advancement and an aging population. Understanding how medical expenditures affect health, and whether this relationship differs by important sociodemographic characteristics such as age, are important for the appropriate allocation of scarce health care resources. Given the current environment of health care reform, further evidence on the health returns to medical investment is both timely and policy-relevant.;This study focuses on health returns to medical spending for the adult population in the United States. It assesses health benefits from overall medical expenditures as well as medical expenditure components (pharmaceutical expenditure and spending on physician services). I consider both objective (EuroQoL) and subjective (rating scale) measures of health. The conceptual point of departure for this study is Grossman's classic model of health investment. This study employs two-stage least squares estimation techniques to address the endogeneity of individual medical expenditures (e.g., that sicker people spend more).;Using the objective health measure, the elasticity of overall medical expenditure with respect to health is approximately 0.26. That is, a 10% increase in medical expenditures increases health by 2.6%. For subjective measure, the elasticity of overall medical expenditure is 0.19. However, the returns to medical expenditures differ by age group and whether I use an objective or subjective health measure. Using the objective measure, the returns to medical expenditure are greatest for the middle-aged group (e.g., 46 to 64 years of age). However, using the subjective measure, I find that the perceived returns to health are greatest for seniors (e.g., > 64 years of age) cohort. If objective health measures provide better evidence of actual gains in health, these findings suggest that reallocation of spending from seniors towards middle-aged cohorts can improve overall health without affecting expenditures. Given the strong perceived benefit for medical expenditures among seniors, however, such a reallocation may meet with considerable resistance.;To better understand the source of health benefit for different age groups, health returns to medical expenditure components are further examined (prescription drug expenditure and physician services expenditure). I find that middle-age group and younger population gain positive health returns (captured by objective measure: health-related quality of life) from prescription expenditure, while no statistically significant correlation has been found between health benefit and prescription drug expenditures for seniors. The period of this study was before the Medicare Part D plan was implemented. Prescription compliance among seniors may have been adversely affected by limited coverage during this period, which could account for this result.;Considering the relationship between physician services spending and health outcome, the results suggest that senior group gains higher health returns (captured by subjective health measure: self-rated health status) comparing to the middle-age and younger group. It indicates that senior group may yield higher "perceived" health benefit from office-based visits, where the type of care is "face-to-face" contact. These findings could inform public policies designed to more closely match specific types of care with those groups likely to benefit the most from them.
机译：在过去的三十年中，医疗支出占GDP的比例翻了一番，这反映了技术的进步和人口的老龄化。了解医疗支出如何影响健康，以及这种关系是否因重要的社会人口统计学特征（例如年龄）而有所不同，对于适当分配稀缺的医疗资源至关重要。鉴于当前的医疗保健改革环境，关于医疗投资的健康回报的进一步证据既及时又具有政策意义。该研究的重点是美国成年人口的医疗支出的健康回报。它评估了整体医疗支出以及医疗支出组成部分（药品支出和医师服务支出）对健康的好处。我同时考虑客观（EuroQoL）和主观（等级量表）健康衡量。这项研究的概念出发点是格罗斯曼（Grossman）的经典卫生投资模型。这项研究采用两阶段最小二乘估计技术来解决个人医疗支出的内生性（例如，生病的人多支出）.;使用客观的健康衡量方法，整体医疗支出相对于健康的弹性约为0.26。也就是说，医疗支出增加10％，健康就会增加2.6％。从主观角度来看，整体医疗支出的弹性为0.19。但是，医疗支出的回报因年龄段以及我使用客观还是主观健康指标而异。使用客观指标，中年组（例如46至64岁）的医疗支出回报最大。但是，通过主观测量，我发现对于老年人（例如，> 64岁）队列，健康的感知回报最大。如果客观的健康措施能够更好地证明实际的健康状况，则这些发现表明，将老年人的支出重新分配给中年人群可以改善整体健康状况，而不会影响支出。然而，考虑到老年人对医疗支出的强烈感知收益，这种重新分配可能会遇到很大的阻力。；为了更好地了解不同年龄组的健康收益的来源，将进一步检查医疗支出组成部分的健康回报（处方药支出和医生服务支出）。我发现中年人和年轻人群从处方药支出中获得了积极的健康回报（客观衡量：与健康有关的生活质量），而在老年人的健康福利和处方药支出之间没有统计上的显着相关性。这项研究的时期是在实施Medicare D部分计划之前。在此期间，老年人的处方依从性可能受到覆盖范围有限的不利影响，这可能是造成这一结果的原因。考虑到医师服务支出与健康结果之间的关系，结果表明，老年人群可以获得更高的健康回报（由主观健康捕获）衡量：自我评估的健康状况）与中年和年轻组的比较。它表明，高级人群通过基于办公室的就诊可能会获得更高的“感知”健康收益，而这种看护的类型是“面对面”接触。这些发现可以为旨在使特定类型的护理与可能从中受益最大的人群更紧密地匹配的公共政策提供参考。

著录项

  • 作者

    Han, Meiying.;

  • 作者单位

    State University of New York at Stony Brook.;

  • 授予单位 State University of New York at Stony Brook.;
  • 学科 Economics General.;Health Sciences General.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 95 p.
  • 总页数 95
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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