@article {11123, title = {Predicting quantity and quality of life with the Future Elderly Model.}, journal = {Health Economics}, year = {2020}, month = {2020 Oct 07}, abstract = {

The Future Elderly Model (FEM) is a microsimulation model designed to forecast health status, longevity, and a variety of economic outcomes. Compared to traditional actuarial models, microsimulation models provide greater opportunities for policy forecasting and richer detail, but they typically build upon smaller samples of data that may mitigate forecasting accuracy. We perform validation analyses of the FEM{\textquoteright}s mortality and quality of life forecasts using a version of the FEM estimated exclusively on early waves of data from the Health and Retirement Study. First, we compare FEM mortality and longevity projections to the actual mortality and longevity experience observed over the same period of time. We also compare the FEM results to actuarial forecasts of mortality and longevity during the same time. We find that FEM projections are generally in line with observed mortality rates and closely match longevity. Then, we assess the FEM{\textquoteright}s performance at predicting quality of life and longitudinal outcomes, two features missing from traditional actuarial models. Our analysis suggests the FEM performs at least as well as actuarial forecasts of mortality, while providing policy simulation features that are not available in actuarial models.

}, keywords = {forecasting and prediction methods, model evaluation, simulation methods, validation and selection}, issn = {1099-1050}, doi = {10.1002/hec.4169}, author = {Leaf, Duncan Ermini and Tysinger, Bryan and Dana P Goldman and Darius Lakdawalla} } @article {9855, title = {Measuring Sarcopenia Severity in Older Adults and the Value of Effective Interventions}, journal = {The journal of nutrition, health \& aging}, year = {2018}, month = {Jun-09-2019}, abstract = {Objectives: Little is known about the severity and long-term health and economic consequences of sarcopenia. We developed a sarcopenia index to measure severity in older Americans and estimated the long-term societal benefits generated by effective interventions to mitigate severity. Design: Using a micro-simulation model, we quantified the potential societal value generated in the US in 2010{\textendash}2040 by reductions in sarcopenia severity in older adults. All analyses were performed in Stata and SAS. Setting \& Participants: Secondary data from the National Health and Nutrition Examination Survey (NHANES) (N = 1634) and Health and Retirement Study (HRS) (N = 952) were used to develop a sarcopenia severity index in older adults. Measurements: Multitrait multi-method and factor analyses were used to validate and calibrate the sarcopenia severity index, which was modeled as a function of gait speed, walking without an assistive device, and moderate physical activity. Results: In representative elderly populations, reducing sarcopenia severity by improving gait speed by 0.1 m/s in those with gait speed under 0.8 m/s generated a cumulative benefit of $65B by 2040 (2015 dollars). Improving walking ability in those with walking difficulty generated cumulative social benefit of $787B by 2040. Conclusions: Reducing sarcopenia severity would generate significant health and economic benefits to society{\textemdash} almost $800B in the most optimistic scenarios. {\textcopyright} 2018, The Author(s). }, keywords = {Economics, health, Physical activity, Sacropenia}, issn = {1279-7707}, doi = {10.1007/s12603-018-1104-7}, url = {http://link.springer.com/10.1007/s12603-018-1104-7http://link.springer.com/content/pdf/10.1007/s12603-018-1104-7.pdf}, author = {MacEwan, Joanna P. and Thomas M Gill and Johnson, K. and Doctor, J. and Jeffrey Sullivan and Shim, J. and Dana P Goldman} } @article {9227, title = {How the growing gap in life expectancy may affect retirement benefits and reforms}, journal = {The Geneva Papers on Risk and Insurance - Issues and Practice}, volume = {42}, year = {2017}, month = {Jan-07-2017}, pages = {475-499}, keywords = {Life Expectancy, Mortality, Retirement Planning and Satisfaction, Social Security}, issn = {1018-5895}, doi = {10.1057/s41288-017-0057-0}, url = {http://link.springer.com/10.1057/s41288-017-0057-0http://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdfhttp://link.springer.com/article/10.1057/s41288-017-0057-0/fulltext.htmlhttp://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdf}, author = {Auerbach, Alan and Kerwin K. Charles and Courtney Coile and William G. Gale and Dana P Goldman and Lee, Ronald and Lucas, Charles and Orszag, Peter R. and Sheiner, Louise and Tysinger, Bryan and Weil, David and Wolfers, Justin and Rebeca Wong} } @article {9155, title = {Using self-reports or claims to assess disease prevalence: It{\textquoteright}s complicated.}, journal = {Medical Care}, volume = {55}, year = {2017}, pages = {782-788}, abstract = {

BACKGROUND: Two common ways of measuring disease prevalence include (1) using self-reported disease diagnosis from survey responses; (2) using disease-specific diagnosis codes found in administrative data. Because they do not suffer from self-report biases, claims are often assumed to be more objective. However, it is not clear that claims always produce better prevalence estimates.

OBJECTIVE: Conduct an assessment of discrepancies between self-report and claims-based measures for 2 diseases in the US elderly to investigate definition, selection, and measurement error issues which may help explain divergence between claims and self-report estimates of prevalence.

DATA: Self-reported data from 3 sources are included: the Health and Retirement Study, the Medicare Current Beneficiary Survey, and the National Health and Nutrition Examination Survey. Claims-based disease measurements are provided from Medicare claims linked to Health and Retirement Study and Medicare Current Beneficiary Survey participants, comprehensive claims data from a 20\% random sample of Medicare enrollees, and private health insurance claims from Humana Inc.

METHODS: Prevalence of diagnosed disease in the US elderly are computed and compared across sources. Two medical conditions are considered: diabetes and heart attack.

RESULTS: Comparisons of diagnosed diabetes and heart attack prevalence show similar trends by source, but claims differ from self-reports with regard to levels. Selection into insurance plans, disease definitions, and the reference period used by algorithms are identified as sources contributing to differences.

CONCLUSIONS: Claims and self-reports both have strengths and weaknesses, which researchers need to consider when interpreting estimates of prevalence from these 2 sources.

}, keywords = {Medicare linkage, Medicare/Medicaid/Health Insurance, Survey Methodology}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000753}, author = {Patricia A St Clair and Gaudette, {\'E}tienne and Zhao, Henu and Tysinger, Bryan and Seyedin, Roxanna and Dana P Goldman} } @article {8811, title = {The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older.}, journal = {PLoS One}, volume = {11}, year = {2016}, month = {2016}, pages = {e0166103}, abstract = {

BACKGROUND: The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease.

METHODS AND FINDINGS: We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40\% of men and 10\% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95\% CI 0.08-0.50) and would add 900,000 people (95\% CI 300,000-1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95\% CI 345-975) in net health benefits over that period.

CONCLUSIONS: Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively.

}, keywords = {Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Cardiovascular Diseases, Female, Humans, Incidence, Life Expectancy, Male, Middle Aged, Nutrition Surveys, Primary Prevention, Quality-Adjusted Life Years, Risk Assessment, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0166103}, url = {http://dx.plos.org/10.1371/journal.pone.0166103}, author = {David B. Agus and Gaudette, {\'E}tienne and Dana P Goldman and Messali, Andrew}, editor = {Song, Qing} } @article {10902, title = {Do Statins Reduce the Health and Health Care Costs of Obesity?}, journal = {Pharmacoeconomics}, volume = {33}, year = {2015}, month = {2015 Jul}, pages = {723-34}, abstract = {

CONTEXT: Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae.

METHODS: Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50~years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins.

RESULTS: Life expectancy gains of statins are estimated to be 5-6~\% greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and~2 obesity (body mass index [BMI] >=30 and >=35~kg/m(2), respectively) and they increase the costs of class~3 obesity (BMI >=40~kg/m(2)) by 1.2~\%.

CONCLUSIONS: Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

}, keywords = {Aged, Computer Simulation, Cost-Benefit Analysis, Health Care Costs, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Life Expectancy, Markov chains, Models, Economic, Obesity, Quality-Adjusted Life Years}, issn = {1179-2027}, doi = {10.1007/s40273-014-0234-y}, author = {Gaudette, {\'E}tienne and Dana P Goldman and Messali, Andrew and Sood, Neeraj} } @article {8033, title = {Heterogeneity in healthy aging.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {69}, year = {2014}, month = {2014 Jun}, pages = {640-9}, publisher = {69}, abstract = {

For a surprisingly large segment of the older population, chronological age is not a relevant marker for understanding, measuring, or experiencing healthy aging. Using the 2003 Medical Expenditure Panel Survey and the 2004 Health and Retirement Study to examine the proportion of Americans exhibiting five markers of health and the variation in health-related quality of life across each of eight age groups, we find that a significant proportion of older Americans is healthy within every age group beginning at age 51, including among those aged 85+. For example, 48\% of those aged 51-54 and 28\% of those aged 85+ have excellent or very good self-reported health status; similarly, 89\% of those aged 51-54 and 56\% of those aged 85+ report no health-based limitations in work or housework. Also, health-related quality of life ranges widely within every age group, yet there is only a comparatively small variation in median quality of life across age groups, suggesting that older Americans today may be experiencing substantially different age-health trajectories than their predecessors. Patterns are similar for medical expenditures. Several policy implications are explored.

}, keywords = {Aged, Aged, 80 and over, Aging, Female, Health Status, Humans, Male, Middle Aged, Population Surveillance, Quality of Life, Retrospective Studies, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glt162}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2013/11/13/gerona.glt162.abstract}, author = {David J Lowsky and S Jay Olshansky and Bhattacharya, Jay and Dana P Goldman} } @article {7742, title = {The Disability burden of COPD.}, journal = {COPD}, volume = {9}, year = {2012}, month = {2012 Aug}, pages = {513-21}, abstract = {

Affecting an estimated 12.6 million people and causing over 100,000 deaths per year, chronic obstructive pulmonary disease (COPD) exacts a heavy burden on American society. Despite knowledge of the impact of COPD on morbidity, mortality, and health care costs, little is known about the association of the disease with economic outcomes such as employment and the collection of disability. We quantify the impact of COPD on Americans aged 51 and older-in particular, their employment prospects and their likelihood of collecting federal disability benefits-by conducting longitudinal regression analysis using the Health and Retirement Study. Controlling for initial health status and a variety of sociodemographic factors, we find that COPD is associated with a decrease in the likelihood of employment of 8.6 percentage points (OR = 0.58, 95\% CI 0.50-0.67), from 44\% to 35\%. This association rivals that of stroke and is larger than those of heart disease, cancer, hypertension, and diabetes. Furthermore, COPD is associated with a 3.9 percentage point (OR 2.52, 95\% CI 2.00-3.17) increase in the likelihood of collecting Social Security Disability Insurance (SSDI), from 3.2\% to 7.1\%, as well as a 1.7 percentage point (OR 2.87, 95\% CI 2.02-4.08) increase in the likelihood of collecting Supplemental Security Income (SSI), from 1.0\% to 2.7\%. The associations of COPD with SSDI and SSI are the largest of any of the conditions studied. Our results are consistent with the hypothesis that COPD imposes a substantial burden on American society by inhibiting employment and creating disability.

}, keywords = {Aged, Cost of Illness, Disabled Persons, Employment, Female, Humans, Income, Insurance, Disability, Likelihood Functions, Logistic Models, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Social Security, United States}, issn = {1541-2563}, doi = {10.3109/15412555.2012.696159}, author = {Thornton Snider, Julia and J. A. Romley and Ken S Wong and Zhang, Jie and Eber, Michael and Dana P Goldman} } @article {7675, title = {Differences in health between Americans and Western Europeans: Effects on longevity and public finance.}, journal = {Soc Sci Med}, volume = {73}, year = {2011}, month = {2011 Jul}, pages = {254-63}, publisher = {73}, abstract = {

In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.

}, keywords = {Activities of Daily Living, Adult, Aged, Body Mass Index, Cross-Cultural Comparison, Disabled Persons, Europe, Female, Health Expenditures, health policy, Health Status Disparities, Health Surveys, Humans, Internationality, Life Expectancy, Male, Middle Aged, Models, Economic, Models, Statistical, Mortality, Public Health, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.05.027}, author = {Pierre-Carl Michaud and Dana P Goldman and Darius Lakdawalla and Adam Gailey and Yuhui Zheng} } @article {7549, title = {Medical Expenditure Measures in the Health and Retirement Study.}, journal = {Forum Health Econ Policy}, volume = {14}, year = {2011}, month = {2011 Apr 01}, pages = {4}, publisher = {14}, abstract = {

This paper reviews out-of-pocket (OOP) medical expenditure measures collected in the Health and Retirement Study (HRS). Medical expenditures are an important cost of poor health. Medical expenditure measures are important for understanding retirement decisions, financial preparation for retirement, and predicting the consequences of health care reform, particularly Medicare reform. Despite the comprehensiveness of the HRS, there are always limitations to what can be learned from population interviews. To assess the quality of current HRS measures of OOP spending, we compare various measures of OOP spending across survey waves to the Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS), two surveys that expend considerable resources on measuring both OOP spending and total medical expenditures. Such comparisons make it possible to identify potential bias in the HRS data and to improve HRS measures of OOP. We find that the HRS produces good quality and useful data on OOP spending.

}, issn = {2194-6191}, doi = {10.2202/1558-9544.1267}, author = {Dana P Goldman and Julie M Zissimopoulos and Yang, Lu} } @article {7537, title = {The fiscal consequences of trends in population health.(Forum: America{\textquoteright}s Looming Fiscal Crisis)}, journal = {National Tax Journal}, volume = {63}, year = {2010}, note = {Magazine/Journal Academic OneFile Gale 2011/02/17 COPYRIGHT 2010 National Tax Association}, pages = {307-330}, publisher = {63}, abstract = {The public burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy--with a concomitant decrease in the public sector{\textquoteright}s annuity burden--but these savings may be offset by worsening functional status which increases health care spending, reduces labor supply, and increases public assistance. Using a health microsimulation model we quantify the competing public finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures. We find that the trends in obesity and smoking have different fiscal consequences and that, because of its more profound effects on morbidity and health care expenditures, obesity represents a larger immediate risk from a fiscal perspective. Uncertainty in residual mortality improvements represents by far the largest risk. Keywords: disability, health care costs, social security, microsimulation JEL Codes: 110, 138, J26}, keywords = {Medicare/Medicaid/Health Insurance, Other, Public Policy}, doi = {10.2307/41791016}, author = {Dana P Goldman and Pierre-Carl Michaud and Darius Lakdawalla and Yuhui Zheng and Adam Gailey and Vaynman, Igor} } @article {5824, title = {Health and Access Effects of New Drugs: Combining Experimental and Non-Experimental Data}, year = {2010}, abstract = {We propose to combine clinical trial and estimates of behavioral responses in the population to quantify the value of new drug innovations when such values cannot be obtained by randomized experiments alone. New drugs are seen as having two distinct effects on patients. First, they can provide better outcomes for patients currently under treatment, due to better clinical efficacy. Second, they can also provide treatment access to more patients, perhaps by reducing side effects or expanding treatment. We compare these clinical and access effects using claims data, data on the arrival rate of new drugs, and the clinical trials literature on the effectiveness of these drugs. We find that the effect of new drug introductions on the number of patients treated accounts for a substantial majority of the value created by new drugs.}, keywords = {Health Conditions and Status, Healthcare, Methodology, Other}, url = {https://depot.erudit.org/bitstream/003241dd/1/CIRPEE10-38.pdf}, author = {Pierre-Carl Michaud and Darius Lakdawalla and Dana P Goldman and Sood, Neeraj and Cong, Ze} } @article {7410, title = {The benefits of risk factor prevention in Americans aged 51 years and older.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Nov}, pages = {2096-101}, publisher = {99}, abstract = {

OBJECTIVES: We assessed the potential health and economic benefits of reducing common risk factors in older Americans.

METHODS: A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project their health and medical spending in prevention scenarios for diabetes, hypertension, obesity, and smoking.

RESULTS: The gain in life span from successful treatment of a person aged 51 or 52 years for obesity would be 0.85 years; for hypertension, 2.05 years; and for diabetes, 3.17 years. A 51- or 52-year-old person who quit smoking would gain 3.44 years. Despite living longer, those successfully treated for obesity, hypertension, or diabetes would have lower lifetime medical spending, exclusive of prevention costs. Smoking cessation would lead to increased lifetime spending. We used traditional valuations for a life-year to calculate that successful treatments would be worth, per capita, $198,018 (diabetes), $137,964 (hypertension), $118,946 (smoking), and $51,750 (obesity).

CONCLUSIONS: Effective prevention could substantially improve the health of older Americans, and--despite increases in longevity--such benefits could be achieved with little or no additional lifetime medical spending.

}, keywords = {Diabetes Mellitus, Health Care Costs, health policy, Health Promotion, Humans, Hypertension, Middle Aged, Models, Biological, Models, Economic, Obesity, Quality-Adjusted Life Years, Risk Reduction Behavior, Smoking, Smoking Prevention, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.172627}, url = {http://sfx.lib.umich.edu:9003/sfx_local?sid=Entrez 3APubMedandid=pmid 3A19762651}, author = {Dana P Goldman and Yuhui Zheng and Girosi, Federico and Pierre-Carl Michaud and S Jay Olshansky and David M Cutler and John W Rowe} } @article {5746, title = {Food Prices and the Dynamics of Body Weight}, year = {2009}, institution = {National Bureau of Economic Research, NBER Working Paper 15096}, abstract = {A popular policy option for addressing the growth in weight has has been the imposition of a fat tax on selected foods that are deemed to promote obesity. Understanding the public economics of fat taxes requires an understanding of how or even whether individuals respond to changes in food prices over the long-term. We study the short- and long-run body weight consequences of changing food prices, in the Health and Retirement Study (HRS). We found very modest short-term effects of price per calorie on body weight, and the magnitudes align with the previous literature. The long-term effect is much bigger, but it takes a long time for the effect to reach the full scale. Within 30 years, a 10 permanent reduction in price per calorie would lead to a BMI increase of 1.5 units (or 3.6 ). The long term effect is an increase of 1.9 units of BMI (or 4.2 ). From a policy perspective, these results suggest that policies raising the price of calories will have little effect on weight in the short term, but might curb the rate of weight growth and achieve weight reduction over a very long period of time.}, keywords = {Consumption and Savings, Health Conditions and Status, Public Policy}, author = {Dana P Goldman and Darius Lakdawalla and Yuhui Zheng} } @article {5772, title = {International Differences in Longevity and Health and Their Economic Consequences}, number = {15235}, year = {2009}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to 1.1 trillion in discounted total health expenditures from 2004 to 2050.}, keywords = {Cross-National, Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Public Policy}, doi = {10.3386/w15235}, author = {Pierre-Carl Michaud and Dana P Goldman and Darius Lakdawalla and Adam Gailey and Yuhui Zheng} } @article {5727, title = {Understanding the Economic Consequences of Shifting Trends in Population Health}, number = {15231}, year = {2009}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {The public economic burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy - with a concomitant decrease in the public-sector{\textquoteright}s annuity burden - but these savings may be offset by worsening functional status, which increases health care spending, reduces labor supply, and increases public assistance. Using a microsimulation approach, we quantify the competing public-finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures (including Social Security and income assistance). Together, the reduction in smoking and the rise in obesity have increased net public-sector liabilities by $430bn, or approximately 4\% of the current debt burden. Larger effects are observed for specific public programs: annual spending is 10\% higher in the Medicaid program, and 7\% higher for Medicare.}, keywords = {Employment and Labor Force, Expectations, Health Conditions and Status, Healthcare, Methodology, Public Policy}, doi = {10.3386/w15231}, author = {Dana P Goldman and Darius Lakdawalla and Pierre-Carl Michaud and Yuhui Zheng and Adam Gailey} } @article {7417, title = {U.S. Pharmaceutical Policy In A Global Marketplace}, journal = {Health Affairs}, volume = {28}, year = {2009}, pages = {w138-w150}, publisher = {28}, abstract = {U.S. consumers generate more pharmaceutical revenue per person than Europeans do. This has led some U.S. policymakers to call for limits on U.S. pharmaceutical spending and prices. Using a microsimulation approach, we analyze the welfare impacts of lowering U.S. prices toward European levels, and how these impacts vary with key modeling assumptions. Under the assumptions most favorable to them, price controls generate modest benefits (a few thousand dollars per person). However, for the remainder of plausible assumptions, price controls generate costs that are an order of magnitude higher. In contrast, publicly financing reductions in consumer prices, without affecting manufacturer prices, delivers benefits in virtually all plausible cases.}, keywords = {Healthcare}, doi = {10.1377/hlthaff.28.1.w138}, author = {Darius Lakdawalla and Dana P Goldman and Pierre-Carl Michaud and Sood, Neeraj and Lempert, Robert and Cong, Ze and de Vries, Han and Italo Gutierrez} } @article {5728, title = {Retirement and Weight}, year = {2008}, institution = {RAND}, abstract = {Retirement from physically demanding work has long served as a healthful respite from backbreaking labor, even if it came too late in life for many. In today s era of expanding waistlines and increasingly sedentary jobs, however, leaving a physically demanding occupation may produce less healthful outcomes. We find that, during the first six years of retirement, males retiring from strenuous jobs appear to gain weight, while those retiring from sedentary jobs lose it. In particular, retirees from strenuous jobs gain approximately 0.5 more units of BMI, and exhibit relative declines in total exercise. The empirical facts suggest both a direct reduction in job-related exercise, and behavioral substitution towards more leisure-time exercise after retirement. Changes in food intake appear to play little to no role. Finally, the evidence suggests that those retiring from strenuous jobs are at least 25 more likely to contract diabetes in their retirement years. This is consistent with the negative health impacts of weight gain and reduced exercise.}, keywords = {Employment and Labor Force, Health Conditions and Status}, url = {http://www.aeaweb.org/assa/2009/retrieve.php?pdfid=219}, author = {Dana P Goldman and Darius Lakdawalla and Yuhui Zheng} } @article {5631, title = {Medical Expenditure Risk and Household Portfolio Choice}, number = {WR-325-1}, year = {2007}, institution = {RAND Labor and Population Program}, address = {Santa Monica, CA}, abstract = {As health care costs continue to rise, medical expenses have become an increasingly important contributor to financial risk. Economic theory suggests that when background risk rises, individuals will reduce their exposure to other risks. This paper presents a test of this theory by examining the effect of medical expenditure risk on the willingness of elderly Medicare beneficiaries to hold risky assets. The authors measure exposure to medical expenditure risk by whether an individual is covered by supplemental insurance through Medigap, an employer, or a Medicare HMO. They account for the endogeneity of insurance choice by using county variation in Medigap prices and non-Medicare HMO market penetration. They find that having Medigap or an employer policy increases risky asset holding by 6 percentage points relative to those enrolled in only Medicare Parts A and B. HMO participation increases risky asset holding by 12 percentage points. Given that just 50 percent of their sample holds risky assets, these are economically sizable effects. It also suggests an important link between the availability and pricing of health insurance and the financial behavior of the elderly.}, keywords = {Medicare/Medicaid/Health Insurance, Risk Taking}, doi = {https://doi.org/10.7249/WR325-1}, author = {Dana P Goldman and Nicole Maestas} } @article {7057, title = {A socioeconomic profile of older adults with HIV.}, journal = {J Health Care Poor Underserved}, volume = {16}, year = {2005}, month = {2005 Feb}, pages = {19-28}, publisher = {16}, 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.

}, keywords = {Female, HIV Infections, Humans, Insurance, Health, Male, Middle Aged, Social Class}, issn = {1049-2089}, doi = {10.1353/hpu.2005.0013}, author = {Joyce, Geoffrey F. and Dana P Goldman and Leibowitz, Arleen A. and Abby Alpert and Bao, Yuhua} } @article {6860, title = {High out-of-pocket health care spending by the elderly.}, journal = {Health Aff (Millwood)}, volume = {22}, year = {2003}, month = {2003 May-Jun}, pages = {194-202}, publisher = {22}, abstract = {

We use data from the Health and Retirement Study to examine the elderly{\textquoteright}s out-of-pocket health care spending. We find that Medicare HMOs, employer supplements, and Medicaid effectively insulate against the risk of high expenditures. At the ninetieth percentile, Medicare beneficiaries with employer supplements or enrolled in Medicare HMOs spend 1,600 dollars less out of pocket than beneficiaries with traditional Medicare spend. For the poor elderly, Medicaid offers similar protection. Among the near-poor elderly, there is little employer coverage, so Medicare HMOs provide most of the protection against financial risk. There is evidence that Medicare HMO benefits have eroded since 1998, raising the question of whether the near-poor have lost financial protection since then.

}, keywords = {Aged, Drug Costs, Drug Prescriptions, Financing, Personal, Health Care Surveys, Health Expenditures, Health Maintenance Organizations, Health Services for the Aged, Humans, Insurance, Health, Medicare, Poverty, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.22.3.194}, author = {Dana P Goldman and Julie M Zissimopoulos} } @article {6814, title = {Can patient self-management help explain the SES health gradient?}, journal = {Proc Natl Acad Sci U S A}, volume = {99}, year = {2002}, month = {2002 Aug 06}, pages = {10929-34}, publisher = {99}, abstract = {

There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation-better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys-one cohort study and one randomized clinical trial-that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.

}, keywords = {Adolescent, Adult, Antiretroviral Therapy, Highly Active, Diabetes Mellitus, Type 1, Educational Status, Female, Health Knowledge, Attitudes, Practice, HIV Infections, Humans, Insulin, Longitudinal Studies, Male, Patient Compliance, Population Surveillance, Prospective Studies, Randomized Controlled Trials as Topic, Self Care, Social Class}, issn = {0027-8424}, doi = {10.1073/pnas.162086599}, author = {Dana P Goldman and James P Smith} } @article {5306, title = {Evaluating Health Care Reform Using the Health and Retirement Survey: A Case Study of the Health Security Act of 1993}, number = {DRU-669-NIA}, year = {1994}, institution = {RAND Corporation}, abstract = {Health care reform could dramatically alter the health care landscape. While there is substantial disagreement over the changes that should be implemented, there appears to be a consensus within the Federal Government that insurance markets need reform. To forecast the likely effects of reform, it is necessary to construct models of consumer behavior. The new Health and Retirement Survey (HRS), because of its thorough data elements and longitudinal sampling frame, is uniquely suited to answer the key behavioral questions associated with health care form. This paper describes how the HRS can be used to forecast some of the likely behavioral responses of mature Americans (aged 51 to 61) to the Health Security Act of 1993 (HSA) and as a benchmark to evaluate the impact of any health care reform. The authors draw attention to the 1992 round of the HRS as a tool for analyzing the likely impact of HSA on insurance choice, health care utilization, health outcomes, family labor supply and retirement, wealth, intergenerational transfers and living arrangements. They discuss how future waves of the HRS could be used to explain the dynamic relationships between deteriorating health, asset decumulation, and employment as individuals move further along the life-cycle.}, keywords = {Healthcare}, url = {https://www.rand.org/pubs/drafts/DRU669.html}, author = {Dana P Goldman and Paul J. Gertler and James P Smith} }