期刊-NBER美国国民经济研究局-spring2006_48页_1mb

NBER Health Care Program Summary - Spring 2006

Core Content

The National Bureau of Economic Research (NBER) Health Care Program is a major research initiative that explores various aspects of health care economics, including the delivery, financing, and impact of health insurance, pharmaceutical markets, and racial disparities in health outcomes. The program includes annual meetings, summer institute sessions, and conferences, and its members contribute to a wide range of studies.

Main Research Areas

1. Private Health Insurance

• Most Americans obtain health insurance through employment.
• Loss of employment-based insurance often leads to enrollment in government programs like Medicaid or loss of coverage entirely.
• Chernew, Cutler, and Keenan found that rising health insurance premiums accounted for over half of the decline in coverage during the 1990s.
• A $1,000 increase in premiums is associated with a 2.6 percentage point decline in insurance coverage.
• They also projected that the number of uninsured could increase by 2 to 6 million by 2010.
• Bundorf and Pauly examined affordability using both normative and behavioral definitions, finding that 82% of the uninsured could afford coverage if income is above the poverty level, while only 34% could afford it at three times the poverty level.
• Bundorf and Bhattacharya studied wage offsets for obese workers with employer-sponsored insurance, finding that these workers receive lower wages to cover higher expected medical costs.

2. Medicare and Medicaid

• Finkelstein analyzed the impact of Medicare on health spending and technology adoption, showing that areas with less pre-existing health insurance saw greater effects.
• Skinner and colleagues found that Medicare expenditures often provide no survival benefit and may not improve quality of life, despite increases in spending.
• Cutler, Skinner, and Fisher examined changes in mortality and costs for Acute Myocardial Infarction (AMI), showing that early investment in low-cost, effective treatments led to greater mortality reductions without increasing costs.
• Duggan and Scott Morton found that Medicaid's influence on drug pricing and innovation leads to higher average prescription prices when Medicaid is a significant market share.

3. Pharmaceutical Markets and Innovation

• Lichtenberg estimated that new drugs contributed to about 40% of the increase in life expectancy between 1986 and 2000.
• Philipson and Jena examined the welfare gains from anti-HIV medications, finding that profits represented only 5% of consumer surplus.
• Jones, Romer, and others explored static and dynamic efficiency in innovation, suggesting that health insurance systems can influence innovation incentives.
• Sood and Lakdawalla proposed that health insurance can be structured to ensure both adequate innovation rewards and patient access.

4. Racial Disparities in Health Care Delivery

• Chandra, Skinner, and Staiger found that geography, rather than race, plays a pivotal role in racial disparities in health outcomes.
• A study on AMI mortality showed that hospitals serving a disproportionate number of African-Americans had significantly higher risk-adjusted mortality rates.
• Groeneveld and others observed that racial disparities in cardiac treatments like implantable cardioverter-defibrillators (ICDs) have declined over time due to reduced geographic variation.
• Levy found that differences in health insurance coverage between racial and gender groups are largely explained by observable characteristics such as education and occupation, with women being less likely to be uninsured than men.

5. Industrial Organization of Medical Care

• Horwitz analyzed hospital service profitability and specialization, finding that for-profit hospitals are more likely to offer profitable services.
• Shen and colleagues synthesized studies on hospital ownership and financial performance, suggesting that differences in theoretical frameworks and assumptions explain the varied results.
• Duggan examined the behavior of not-for-profit hospitals in relation to for-profit competition, finding that not-for-profit hospitals in areas with more for-profit providers are more responsive to financial incentives.
• Gaynor, Rebitzer, and Taylor explored how physician incentives in HMO networks affect medical expenditures and quality of care, finding that financial incentives can lead to a 5% reduction in costs.

Key Information

• The NBER provides a free email service for daily updates on U.S. government data releases.
• The Health Care Program is one of the largest and most active within the NBER.
• The research highlights the complex interactions between health insurance, medical innovation, and health outcomes.
• Racial and gender disparities in health care are influenced by geographic factors and differences in insurance access.
• Pharmaceutical industry trends and ownership structures have significant implications for innovation and pricing.

Conclusion

The NBER Health Care Program's research offers critical insights into the economic forces shaping health care delivery, financing, and innovation. It underscores the importance of understanding how insurance structures, market dynamics, and policy interventions affect health outcomes and costs, with particular attention to disparities among different demographic groups.