March 28, 2013
Health care spending in three states – Maine, West Virginia and Mississippi – accounts for one out of every five dollars of state GDP. Conversely, Wyoming spends less one in ten, according to a new study by the National Center for Policy Analysis (NCPA).
“If every state could be like Wyoming, which they cannot, the country as a whole would be spending less of its income on health care than about three-fourths of the other developed countries,” said former Medicare Trustee and NCPA Senior Fellow Thomas R. Saving.
via NCPA Study: Why Do Some States Spend More on Health Care? | NCPA.
March 26, 2013
the gap between the health haves and the have-nots has narrowed dramatically in recent years.
The haves are those who enjoy great health into their 90s. The have-nots are those who suffer from serious health problems and do not live to see adulthood. As we pointed out in a recent study, among those Americans who were born in 1975, the unluckiest 1 percent died in infancy, while the luckiest 1 percent can expect to live to age 105 or longer. Now let’s fast forward to those born in 2012. The bottom percentile of this cohort can expect to survive until age 18. At the other end of the spectrum, the luckiest 1 percent can expect to live to age 108. That’s a much bigger gain in life expectancy among the have-nots than among the haves. Of course, life expectancy is but one measure of health and well-being, but understanding these trends offers a more complete picture than considering income alone.
via The Shrinking Health Gap — The American Magazine.
March 17, 2013
Five months after the commission filed its final report, Governor Corzine introduced and New Jersey’s State Assembly passed Assembly Bill No. 2609. It limits the maximum allowable price that can be charged to uninsured New Jersey residents with incomes up to 500 percent of the federal poverty level to what Medicare pays plus 15 percent, terms the governor’s office had negotiated with New Jersey’s hospital industry.
via Uwe E. Reinhardt: What Hospitals Charge the Uninsured – NYTimes.com.
March 14, 2013
The overwhelming majority of biological scientists agree that there is no such thing as race among modern humans. Yet, scientists regularly deploy race in their studies, and federal laws and regulations currently mandate the use of racial categories in biomedical research. Legal commentators have tried to make sense of this paradox primarily by looking to equal protection strict scrutiny analysis. However, the colorblind approach that attends this doctrine — which many regard as synonymous with invalidation — does not offer a particularly useful way to think about the use of race in research. It offers no way to address how current uses of race in science serve to reinforce biological notions of race long thought discarded. This Article, therefore, takes a different approach by shifting the debate from how strict scrutiny analysis can bear on race-based research, to asking a much deeper question: What normative aims motivate this jurisprudence and can they be instructive in mapping appropriate and equality-enhancing regulations for the use of race in biomedical research? Despite the Supreme Court’s apparent discomfort with government invocations of race, this Article locates in its equal protection race cases elements of an overlooked line of analysis that this Article terms “racial pragmatism,” according to which certain government race-conscious decisionmaking will not trigger strict scrutiny review. By parsing through the Court’s recent race cases, this Article identifies the goals and concerns that accompany racial pragmatist reasoning and brings them to bear in the biomedical research context to offer a framework for how regulators can mandate the use of race in research without dangerously “geneticizing” race.
via The Regulation of Race in Science by Kimani Paul-Emile :: SSRN.
March 14, 2013
The public health care systems in the Nordic countries provide high quality care almost free of charge to all citizens. However, social inequalities in health persist. Previous research has, for example, documented substantial educational inequalities in cancer survival. We investigate to what extent this may be driven by differential access to and utilization of high quality treatment options. Quasi-experimental evidence based on the establishment of regional cancer wards indicates that i) highly educated individuals utilized centralized specialized treatment to a greater extent than less educated patients and ii) the use of such treatment improved these patients’ survival.
via Access to Treatment and Educational Inequalities in Cancer Survival by Jon Fiva, Torbjorn Haegeland, Marte Ronning, Astri Syse :: SSRN.
March 13, 2013
Are you ready? The 2013 County Health Rankings will be released on March 20, 2013. Now for the fourth year in a row, counties can see a snapshot of how healthy their residents are by comparing their overall health and the factors that influence their health with other counties in their state. This allows communities to see county-by-county where they are doing well and where they need to improve.
via County Health Rankings.
March 12, 2013
To evaluate the distributional effects of some proposed Social Security law changes, such as an increase in Social Security’s early entitlement age, retirement policy analysts typically tabulate the number of workers who fall below a predetermined threshold of hardship. Analysts using this technique often implicitly assume that the insured population falls neatly into a low-earnings poor health group and a remaining good health group. If the hardship threshold assumption is correct, there should be no difference in mortality risk between lifetime earnings deciles above a hardship threshold. This study finds that the hardship threshold model is overwhelmingly rejected in US Social Security data, a result consistent with similar studies conducted in Canada, Germany, and England. The bottom 80-95 percent of the male lifetime earnings distribution exhibits an inverse correlation with regard to mortality risk (the higher the earnings, the lower the mortality risk) at ages 63-71.
via Mortality Differentials by Lifetime Earnings Decile: Implications for Evaluations of Proposed Social Security Law Changes by Hilary Waldron :: SSRN.
March 11, 2013
Even though most American retirees benefit from Medicare coverage, a mounting body of research predicts that many will face large and increasing out-of-pocket expenditures for healthcare costs in retirement and that many already struggle to finance these costs. It is unclear, however, whether the general population understands the likely magnitude of these out-of-pocket expenditures well enough to plan for them effectively. This study is the first comprehensive examination of Americans’ expectations regarding their out-of-pocket spending on healthcare in retirement. We surveyed over 1700 near retirees and retirees to assess their expectations regarding their own spending and then compared their responses to experts’ estimates. Our main findings are twofold. First, overall expectations of out-of-pocket spending are mixed. While a significant proportion of respondents estimated out-of-pocket costs in retirement at or above expert estimates of what the typical retiree will spend, a disproportionate number estimated their future spending substantially below what experts view as likely. Estimates by members of some demographic subgroups, including women and younger respondents, deviated relatively further from the experts’ estimates. Second, respondents consistently misjudged spending uncertainty. In particular, respondents significantly underestimated how much individual health experience and changes in government policy can affect individual out-of-pocket spending. We discuss possible policy responses, including efforts to improve financial planning and ways to reduce unanticipated financial risk through reform of health insurance regulation.
via Retiree Out-of-Pocket Healthcare Spending: A Study of Consumer Expectations and Policy Implications by Allison Hoffman, Howell Jackson :: SSRN.
March 11, 2013
One of medicine’s open secrets is that patients routinely refuse or demand medical treatment based on the assigned physician’s racial identity, and hospitals typically yield to patients’ racial preferences. This widely practiced, if rarely acknowledged, phenomenon — about which there is new empirical evidence — poses a fundamental dilemma for law, medicine, and ethics. It also raises difficult questions about how we should think about race, health, and individual autonomy in this context. Informed consent rules and common law battery dictate that a competent patient has an almost-unqualified right to refuse medical care, including treatment provided by an unwanted physician. Yet the accommodation of patients’ racial preferences with respect to their choice of physician in the hospital context appears to violate antidiscrimination principles. How should we reconcile this apparent conflict between respect for patient autonomy and accepted notions of racial equality? Moreover, is the accommodation of patients’ racial preferences the type of invidious discrimination that civil rights laws were enacted to prevent?
This Article engages these questions through an evaluation of antidiscrimination norms, principles of medical ethics, and federal laws, including Titles II, VI, and VII of the Civil Rights Act. In so doing, the Article offers critical insights into why a form of discrimination that is prohibited in other contexts is tolerated in the hospital setting and draws important conclusions about the legal propriety and medical efficacy of this practice. The Article contends that the various titles of the Civil Rights Act offer no clear legal directive on this practice, and it makes the counterintuitive claim that although hospital accommodation of patients’ racial preferences appears to contravene antidiscrimination principles, it is not only consistent with our normative commitments to racial equality but, in fact, constitutes an effective means of alleviating race-based health disparities, improving health outcomes, and quite possibly, saving patients’ lives.
via Patients’ Racial Preferences and the Medical Culture of Accommodation by Kimani Paul-Emile :: SSRN.
March 11, 2013
This paper confirms recent studies which find little or no sustained increase in the inequality of disposable income for the U.S. population as a whole over the past 20 years, even though estimates of the top 1 percent’s share of pretax, pretransfer (market) income spiked upward in 1986-88, 1997-2000 and 2003-2007. It has become commonplace to use top 1 percent shares of market income as a shorthand measure of inequality, and as an argument for greater taxes on higher incomes and/or larger transfer payments to the bottom 90 percent. This paper finds the data inappropriate for such purposes for several reasons
via The Misuse of Top 1 Percent Income Shares as a Measure of Inequality by Alan Reynolds :: SSRN.