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Medicare Growth, Technological Advances, and the Distribution of Health Care Benefits

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?.

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Medicare Growth, Technological Advances, and the Distribution of Health Care Benefits

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

  2. 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?

  3. 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).

  4. 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)

  5. 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?

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

  7. 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)

  8. Percentage Increase in Money Income 1992-2001

  9. Percentage Increase in Full Income (1): Money Income plus Medicare Expenditures, 1992-2001

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

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

  12. 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

  13. 1997$ 2500 Lowest Income Decile 2000 Highest Income 1500 Decile 1000 500 0 1989 1987 1993 1995 1997 1999 2001 1991 Average Home Health Care Spending By Decile 1987-2001: Men Age 80-84 in 1987

  14. Home Health Care Expenditures 1996 by Region

  15. Next Measure: Changes over time in Income Including Lifespan

  16. 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”)

  17. 10-Year Survival Rates Rose in Highest Income Deciles by More than in Lowest Income Deciles 1992-2001 1982-91

  18. Percentage Increase in Full Income (2): Money Income plus Value of Life Extension, 1992-2001

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

  20. Causes of 90-Day AMI Mortality Decline, 1975-1990Source: Heidenrich and McClellan, 2001 No Significant Impact: CABG, calcium antagonists, PTCA (non-primary), nitrates, anticoagulants, etc.

  21. Effective Care Following AMI: By Zip Code Income

  22. 100.0 80.0 60.0 40.0 20.0 0.0 Beta Blocker Use By RegionSource: Dartmouth Atlas Percent of “Ideal” Patients Receiving Beta Blockers at Discharge Following AMI (1994-95)

  23. Income per Capita in 2000 andAverage 1-Year AMI Mortality (1989-2000) by State

  24. Putnam’s Social Capital Index andAverage 1-Year Mortality (1989-2000) by State

  25. Medicare Expenditures (Age 70-74 M) by Year (1982-91 or 1992-2001) Decile 1 in 1992 Decile 10 in 1992 Decile 1,10 in 1982

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