Showing papers by "Dana P. Goldman published in 2005"
TL;DR: A microsimulation is used to estimate lifetime costs, life expectancy, disease, and disability for seventy-year-olds based on body mass and finds obesity might cost Medicare more than other diseases, because higher costs are not offset by reduced longevity.
Abstract: Obesity could have serious consequences for older cohorts. We used a microsimulation to estimate lifetime costs, life expectancy, disease, and disability for seventy-year-olds based on bo...
186 citations
TL;DR: It is unlikely that a "silver bullet" will emerge to both improve health and dramatically reduce medical spending over the next thirty years, and ten of the most promising medical technologies are forecast to increase spending greatly.
Abstract: Recent innovations in biomedicine seem poised to revolutionize medical practice. At the same time, disease and disability are increasing among younger populations. This paper considers ho...
177 citations
TL;DR: Using data from Los Angeles County, it is found that most of the insurance disparities between the foreign-born and native-born can be explained by traditional socioeconomic factors, but undocumented immigrants have lower rates of coverage-both private and public-even after a wide array of factors are controlled for.
Abstract: The foreign-born represent a disproportionate share of nonelderly U.S. adults without health insurance. Using data from Los Angeles County, we find that most of the insurance disparities between the foreign-born and native-born can be explained by traditional socioeconomic factors. Undocumented immigrants, however, have lower rates of coverage—both private and public—even after a wide array of factors are controlled for. Applying Los Angeles County rates to the U.S. population implies that undocumented immigrants account for one-third of the total increase in the number of uninsured adults in the United States between 1980 and 2000.
145 citations
TL;DR: A model of how health disparities are determined that does not depend on the precise causal mechanism is developed and suggests that there are wider disparities by education among the chronically ill populations—precisely the population one would expect to be the heaviest health care users.
Abstract: Better-educated people are healthier, although the sources of this relationship remain unclear. Starting with basic principles of consumer theory, we develop a model of how health disparities are determined that does not depend on the precise causal mechanism. Improvements in the productivity of health care disproportionately benefit the heaviest health care users. Since richer 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 health care productivity—could widen socioeconomic disparities in health. An exception to this rule, however, is a simplifying technology, which can contract health disparities, since richer patients are more likely to invest effort in adhering to complex treatment regimens. We present a few empirical case studies to help illustrate the theoretical results. First, we show that a complicated treatment regimen (antiretroviral therapy for HIV) benefited well-educated patients disproportionately. In contrast, simplifying drugs for hypertension coincided with a contraction in cardiovascular disparities not seen in other diseases. Finally, nationally representative data suggest that there are wider disparities by education among the chronically ill populations—precisely the population one would expect to be the heaviest health care users.
86 citations
TL;DR: The impact of selected chronic diseases on the distribution of health spending and its variation over the course of disease is examined and a microsimulation model is used to estimate these conditions' impact on life expectancy and health spending from age sixty-five to death.
Abstract: The high costs of treating chronic diseases suggest that reducing their prevalence would improve Medicare's financial stability. In this paper we examine the impact of selected chronic diseases on the distribution of health spending and its variation over the course of disease. We also use a microsimulation model to estimate these conditions’ impact on life expectancy and health spending from age sixty-five to death. A sixty-five-year-old with a serious chronic illness spends $1,000–$2,000 more per year on health care than a similar adult without the condition. However, cumulative Medicare payments are only modestly higher for the chronically ill because of their shorter life expectancy.
84 citations
TL;DR: Using estimates of spending trends by disability category, it is projected that the cost savings associated with improved disability rates will not dramatically slow Medicare spending in the long run.
Abstract: This paper forecasts the impact of changing disability rates on spending by Medicare beneficiaries. We adjust for differential changes in spending by the disabled because the composition ...
59 citations
TL;DR: Examination of the short and long-term diffusion of two important classes of anti-hypertensives over the last twenty-five years suggests that - at least for hypertension - SES differences in the adoption of new medical technologies are not an important reason for the SES health gradient.
Abstract: New medical technologies hold tremendous promise for improving population health, but they also raise concerns about exacerbating already large differences in health by socioeconomic status (SES). If effective treatments are more rapidly adopted by the better educated, SES health disparities may initially expand even though the health of those in all groups eventually improves. Hypertension provides a useful case study. It is an important risk factor for developing cardiovascular disease, the condition is relatively common, and there are large differences in rates of hypertension by education. This paper examines the short and long-term diffusion of two important classes of anti-hypertensives - ACE inhibitors and calcium channel blockers - over the last twenty-five years. Using three prominent medical surveys, we find no evidence that the diffusion of these drugs into medical practice favored one education group relative to another. The findings suggest that - at least for hypertension - SES differences in the adoption of new medical technologies are not an important reason for the SES health gradient.
40 citations
03 May 2005
TL;DR: The chart book as mentioned in this paper provides an overview of key health care policy issues in the areas of cost, access, and quality, focusing on the nation as a whole, and is based on material prepared for a series of public meetings organized by the Communications Institute in California.
Abstract: Focusing on the nation as a whole, this chart book provides an overview of key health care policy issues in the areas of cost, access, and quality. Health policy experts at RAND have assembled this chart book to provide a factual basis for addressing the nation’s health care challenges. It is based on material prepared for a series of public meetings organized by the Communications Institute in California.
33 citations
TL;DR: The likelihood, potential impact, and potential cost implications for thirty-four innovations in four domains: cardiovascular disease, cancer, the biology of aging, and neurologic disease are evaluated.
Abstract: We used a method that combined literature review and expertjudgment to assess potential medical innovations for older adults. We evaluated innovations in four domains: cardiovascular disease, cancer, the biology of aging, and neurologic disease. The innovations can be categorized by common themes: improved disease prevention, better detection of subclinical or early clinical disease, and treatments for established disease. We report the likelihood, potential impact, and potential cost implications for thirty-four innovations, and we revisit this forecast five years later. Many of the innovations have the potential to greatly affect the costs and outcomes of health care.
29 citations
TL;DR: It was found that nearly 10% of the HIV-positive population is between the ages of 50 and 61 years, and older whites with HIV are mostly homosexual men who are more well educated, more often privately insured, and more financially stable than the HIV population as a whole.
Abstract: The objective of this study was to assess the socioeconomic circumstances of older patients with HIV and acquired immunodeficiency syndrome (AIDS). The investigators compared subjects from a national probability sample of 2,864 respondents from the HIV Cost and Services Utilization Study (HCSUS, 1996) with 9,810 subjects from Wave 1 (1992) of the Health and Retirement Survey (HRS). Bivariate analyses compare demographic characteristics, financial resources, and health insurance status between older and younger adults and between older adults with HIV and the general population. It was found that nearly 10% of the HIV-positive population is between the ages of 50 and 61 years. Older whites with HIV are mostly homosexual men who are more well educated, more often privately insured, and more financially stable than the HIV population as a whole. In contrast, older minorities with HIV possess few economic resources in either absolute or relative terms. The success of new drug therapies and the changing demographics of the HIV population necessitate innovative policies that promote labor force participation and continuous access to antiretroviral therapies.
27 citations
TL;DR: Applying the Future Elderly Model, it is found that no scenario holds major promise for guaranteeing the future financial health of Medicare.
Abstract: This paper forecasts the consequences of scientific progress in cancer for total Medicare spending between 2005 and 2030. Because technological advance is uncertain, widely varying scenar...
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TL;DR: The authors examined employee compensation decisions during a three-year period when health insurance premiums were rising rapidly and found that about two-thirds of the premium increase was financed out of cash wages and the remaining one-thirds was financed by a reduction in benefits.
Abstract: Many companies have defined-contribution benefit plans requiring employees to pay the full cost (before taxes) of more generous health insurance choices. Research has shown that employee decisions are quite responsive to these arrangements. What is less clear is how the total compensation package changes when health insurance premiums rise. This paper examines employee compensation decisions during a three-year period when health insurance premiums were rising rapidly. The data come from a single large firm with a flexible benefits plan wherein employees explicitly choose how to allocate compensation between cash wages and other benefits. Under such an arrangement, higher health insurance premiums must induce changes in the composition of total compensation -- either in lower after-tax wages or in decreased contributions to other benefits. The results suggest that about two-thirds of the premium increase is financed out of cash wages and the remaining one-thirds is financed by a reduction in benefits.
TL;DR: In this paper, the authors examine how employees reallocate compensation in response to an increase in health insurance premiums and find that a $1 increase in insurance premiums leads to a 52-cent increase in healthcare expenditures.
TL;DR: In this paper, the authors examined employee compensation decisions during a three-year period when health insurance premiums were rising rapidly, and found that the majority of the decisions were made by managers.
Abstract: This paper examines employee compensation decisions during a three-year period when health insurance premiums were rising rapidly.
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TL;DR: The authors examined the short and long-term diffusion of two important classes of anti-hypertensives -ACE inhibitors and calcium channel blockers - over the last twenty-five years and found no evidence that the diffusion of these drugs into medical practice favored one education group relative to another.
Abstract: New medical technologies hold tremendous promise for improving population health, but they also raise concerns about exacerbating already large differences in health by socioeconomic status (SES). If effective treatments are more rapidly adopted by the better educated, SES health disparities may initially expand even though the health of those in all groups eventually improves. Hypertension provides a useful case study. It is an important risk factor for developing cardiovascular disease, the condition is relatively common, and there are large differences in rates of hypertension by education. This paper examines the short and long-term diffusion of two important classes of anti-hypertensives - ACE inhibitors and calcium channel blockers - over the last twenty-five years. Using three prominent medical surveys, we find no evidence that the diffusion of these drugs into medical practice favored one education group relative to another. The findings suggest that - at least for hypertension - SES differences in the adoption of new medical technologies are not an important reason for the SES health gradient.
Posted Content•
TL;DR: This paper examined the short and long-term diffusion of two important classes of anti-hypertensives -ACE inhibitors and calcium channel blockers - over the last twenty-five years and found no evidence that the diffusion of these drugs into medical practice favored one education group relative to another.
Abstract: New medical technologies hold tremendous promise for improving population health, but they also raise concerns about exacerbating already large differences in health by socioeconomic status (SES). If effective treatments are more rapidly adopted by the better educated, SES health disparities may initially expand even though the health of those in all groups eventually improves. Hypertension provides a useful case study. It is an important risk factor for developing cardiovascular disease, the condition is relatively common, and there are large differences in rates of hypertension by education. This paper examines the short and long-term diffusion of two important classes of anti-hypertensives - ACE inhibitors and calcium channel blockers - over the last twenty-five years. Using three prominent medical surveys, we find no evidence that the diffusion of these drugs into medical practice favored one education group relative to another. The findings suggest that - at least for hypertension - SES differences in the adoption of new medical technologies are not an important reason for the SES health gradient.
Journal Article•
TL;DR: In this article, the authors proposed solutions for the creation of individual health savings accounts (HSAs) that can be used to pay for medical care, including outpatient drugs, including cancer drugs.
Abstract: Formulary decisions are often made on the basis of ingredient costs and manufacturer rebates rather than clinical outcomes. Decisions are based on aggregate measures without tailoring to each patient's circumstances. Proposed solutions include creation of individual health savings accounts (HSAs) that can be used to pay for medical care, including outpatient drugs.
01 Jan 2005
TL;DR: Using estimates of spending trends by disability category, it is projected that the cost savings associated with improved disability rates will not dramatically slow Medicare spending in the long run.
Abstract: This paper forecasts the impact of changing disability rates on spending by Medicare beneficiaries. We adjust for differential changes in spending by the disabled be- cause the composition of the disabled population and the intensity of their treatment are changing. Among community-dwelling elderly, spending growth among the least disabled grew more quickly than among the most disabled, which offsets some of the cost savings associated with declining disability rates. Using estimates of spending trends by disability category, we project that the cost savings associated with improved disability rates will not dramatically slow Medicare spending in the long run.
11 Oct 2005
TL;DR: The authors discuss financial aid measures that the federal government could take to help victims of Hurricanes Katrina and Rita cope with the sudden loss of paychecks and employer sponsored health insurance that left them facing a health care crisis.
Abstract: The authors discuss financial aid measures that the federal government could take to help victims of Hurricanes Katrina and Rita cope with the sudden loss of paychecks and employer sponsored health insurance that left them facing a health care crisis.
01 Jan 2005
TL;DR: In this paper, the authors examined the impact of selected chronic diseases on the distribution of health spending and its variation over the course of disease and used a microsimulation model to estimate these conditions' impact on life expectancy and health spending.
Abstract: The high costs of treating chronic diseases suggest that reducing their preva- lence would improve Medicare's financial stability. In this paper we examine the impact of selected chronic diseases on the distribution of health spending and its variation over the course of disease. We also use a microsimulation model to estimate these conditions' im- pact on life expectancy and health spending from age sixty-five to death. A sixty-five-year-old with a serious chronic illness spends $1,000-$2,000 more per year on health care than a similar adult without the condition. However, cumulative Medicare payments are only mod- estly higher for the chronically ill because of their shorter life expectancy.