@article {Sneed2022.02.07.22270614, title = {Chronic Disease and Workforce Participation Among Medicaid Enrollees Over 50: The Potential Impact of Medicaid Work Requirements Post-COVID-19}, journal = {medRxiv}, year = {Forthcoming}, abstract = {As the COVID-19 pandemic wanes, states may reintroduce Medicaid work requirements to reduce enrollment. Using the Health and Retirement Study, we evaluated chronic disease burden among beneficiaries aged \>50 (n=1460) who might be impacted by work requirements (i.e. working \<20 hours per week). Seven of eight chronic conditions evaluated were associated with reduced workforce participation, including history of stroke (OR: 7.35; 95\% CI: 2.98-18.14) and lung disease (OR: 4.39; 95\% CI: 2.97-7.47). Those with more severe disease were also more likely to work fewer hours. Medicaid work requirements would likely have great impact on older beneficiaries with significant disease burden.Key PointsChronic disease linked to reduced work among older Medicaid beneficiaries.Work requirements would greatly impact those aged \>50 with chronic conditions.Coverage loss would have negative implications for long-term disease management.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported by the Robert Wood Johnson Foundation{\textquoteright}s (RWJF) Policies for Action program under grant number 77342. This is a secondary analysis that uses data from the Health and Retirement Study, (2016 HRS Core and RAND HRS Longitudinal File 2018), sponsored by the National Institute on Aging under grant number NIA U01AG009740 and conducted by the University of Michigan.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This study involved only openly available human data, which can be obtained from: https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018 and https://hrsdata.isr.umich.edu/data-products/2016-hrs-coreI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data are available online at: https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018 and https://hrsdata.isr.umich.edu/data-products/2016-hrs-core}, keywords = {Chronic disease, COVID-19, health policy, Medicaid}, doi = {10.1101/2022.02.07.22270614}, author = {Rodlescia S. Sneed and Stubblefield, Alexander and Gardner, Graham and Jordan, Tamara and Briana Mezuk} } @article {13748, title = {Cost of care for Alzheimer{\textquoteright}s disease and related dementias in the United States: 2016 to 2060.}, journal = {NPJ Aging}, volume = {10}, year = {2024}, pages = {13}, abstract = {

Medical and long-term care for Alzheimer{\textquoteright}s disease and related dementias (ADRDs) can impose a large economic burden on individuals and societies. We estimated the per capita cost of ADRDs care in the in the United States in 2016 and projected future aggregate care costs during 2020-2060. Based on a previously published methodology, we used U.S. Health and Retirement Survey (2010-2016) longitudinal data to estimate formal and informal care costs. In 2016, the estimated per patient cost of formal care was $28,078 (95\% confidence interval [CI]: $25,893-$30,433), and informal care cost valued in terms of replacement cost and forgone wages was $36,667 ($34,025-$39,473) and $15,792 ($12,980-$18,713), respectively. Aggregate formal care cost and formal plus informal care cost using replacement cost and forgone wage methods were $196 billion (95\% uncertainty range [UR]: $179-$213 billion), $450 billion ($424-$478 billion), and $305 billion ($278-$333 billion), respectively, in 2020. These were projected to increase to $1.4 trillion ($837 billion-$2.2 trillion), $3.3 trillion ($1.9-$5.1 trillion), and $2.2 trillion ($1.3-$3.5 trillion), respectively, in 2060.

}, keywords = {Alzheimer, cost, Dementia, Health Care, health policy}, issn = {2731-6068}, doi = {10.1038/s41514-024-00136-6}, author = {Nandi, Arindam and Counts, Nathaniel and Br{\"o}ker, Janina and Malik, Sabrina and Chen, Simiao and Han, Rachael and Klusty, Jessica and Seligman, Benjamin and Tortorice, Daniel and Vigo, Daniel and Bloom, David E} } @article {12812, title = {Association Between Supplemental Nutrition Assistance Program Use and Memory Decline: Findings From the Health and Retirement Study.}, journal = {Neurology}, year = {2023}, abstract = {

BACKGROUND AND OBJECTIVES: Studies on the effect of the Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. We sought to examine the associations between SNAP use and memory decline among SNAP-eligible US older adults.

METHODS: Participants aged 50+ and SNAP-eligible in 1996 from the Health and Retirement Study were included. Participants{\textquoteright} SNAP eligibility was constructed using federal criteria. Participants also self-reported whether they used SNAP. Memory function was assessed biennially from 1996 through 2016 using a composite score. To account for pre-existing differences in characteristics between SNAP users and non-users, we modeled the probability of SNAP use using demographic and health covariates. Using linear mixed-effect models, we then modeled trajectories of memory function for SNAP users and non-users using inverse probability (IP) weighting and propensity score (PS) matching techniques. In all models, we accounted for study attrition.

RESULTS: Of the 3,555 SNAP-eligible participants, a total of 15.7\% were SNAP users. At baseline, SNAP users had lower socioeconomic status and a greater number of chronic conditions than non-users, and were more likely to be lost to follow-up. Our multivariable IP-weighted models (N=3,555) suggested SNAP users had worse memory scores at baseline but slower rates of memory decline compared with non-users (annual decline rate is -0.038 standardized units [95\%CI=-0.044, -0.032] for users and -0.046 [95\%CI=-0.049, -0.043] for non-users). Results were slightly stronger from the PS-matched sample (N=1,014) (annual decline rate was -0.046 units [95\%CI=-0.050; -0.042] for users and -0.060 units [95\%CI=-0.064, -0.056] for non-users). Put in other words, our findings suggested that SNAP users had about 2 fewer years of cognitive aging over a 10-year period compared with non-users.

DISCUSSION: After accounting for pre-existing differences between SNAP users and non-users as well as differential attrition, we find SNAP use to be associated with slower memory function decline.

}, keywords = {cognitive aging, government food benefits, health policy, SNAP}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000201499}, author = {Lu, Peiyi and Kezios, Katrina and Lee, Jongseong and Calonico, Sebastian and Wimer, Christopher and Al Hazzouri, Adina Zeki} } @article {12204, title = {The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises.}, journal = {Lancet}, volume = {397}, year = {2021}, pages = {129-170}, keywords = {Climate Change, Conservation of Natural Resources, COVID-19, Extreme Weather, Global Health, health policy, Humans, International Cooperation, Pandemics, SARS-CoV-2}, issn = {1474-547X}, doi = {10.1016/S0140-6736(20)32290-X}, author = {Watts, Nick and Amann, Markus and Arnell, Nigel and Ayeb-Karlsson, Sonja and Beagley, Jessica and Belesova, Kristine and Boykoff, Maxwell and Byass, Peter and Cai, Wenjia and Campbell-Lendrum, Diarmid and Capstick, Stuart and Chambers, Jonathan and Coleman, Samantha and Dalin, Carole and Daly, Meaghan and Dasandi, Niheer and Dasgupta, Shouro and Davies, Michael and Di Napoli, Claudia and Dominguez-Salas, Paula and Drummond, Paul and Dubrow, Robert and Ebi, Kristie L and Eckelman, Matthew and Ekins, Paul and Escobar, Luis E and Georgeson, Lucien and Golder, Su and Grace, Delia and Graham, Hilary and Haggar, Paul and Hamilton, Ian and Hartinger, Stella and Hess, Jeremy and Hsu, Shih-Che and Hughes, Nick and Jankin Mikhaylov, Slava and Marcia P Jimenez and Kelman, Ilan and Kennard, Harry and Kiesewetter, Gregor and Kinney, Patrick L and Kjellstrom, Tord and Kniveton, Dominic and Lampard, Pete and Lemke, Bruno and Liu, Yang and Liu, Zhao and Lott, Melissa and Lowe, Rachel and Martinez-Urtaza, Jaime and Maslin, Mark and McAllister, Lucy and McGushin, Alice and McMichael, Celia and Milner, James and Moradi-Lakeh, Maziar and Morrissey, Karyn and Munzert, Simon and Murray, Kris A and Neville, Tara and Nilsson, Maria and Sewe, Maquins Odhiambo and Oreszczyn, Tadj and Otto, Matthias and Owfi, Fereidoon and Pearman, Olivia and Pencheon, David and Quinn, Ruth and Rabbaniha, Mahnaz and Robinson, Elizabeth and Rockl{\"o}v, Joacim and Romanello, Marina and Semenza, Jan C and Sherman, Jodi and Shi, Liuhua and Springmann, Marco and Tabatabaei, Meisam and Taylor, Jonathon and Tri{\~n}anes, Joaquin and Shumake-Guillemot, Joy and Vu, Bryan and Wilkinson, Paul and Winning, Matthew and Gong, Peng and Montgomery, Hugh and Costello, Anthony} } @article {11363, title = {Factors associated with healthy ageing: a comparative study between China and the United States}, journal = {China Population and Development Studies}, year = {2021}, abstract = {This study compares the associators of healthy ageing in China and the United States, using the 2005{\textendash}2014 Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the 2004{\textendash}2014 Health and Retirement Study (HRS). Health ageing is measured using an overall healthy ageing index (HAI), defined according to five dimensions: no major chronic diseases, free of physical functional impairment, free of cognitive impairment, no depressive symptoms, and socially active engagement. Multilevel logistic regression analysis is adopted to explore the association of demographic characteristics, socioeconomic status, and healthy lifestyles with the odds ratios of healthy ageing in China and the United States. Results indicate that the proportion of individuals experiencing healthy ageing is slightly higher in US than Chinese older adults aged 65{\textendash}100 (25.67\% vs 23.27\%). Nevertheless, Chinese oldest-old (80{\textendash}100) have a higher proportion of healthy ageing than American oldest-old (15.05\% vs. 12.19\%). Our results indicate that the odds of healthy ageing decrease with age, whereas they increase with education, income, marriage, and health behaviours. The odds of healthy ageing are lower for older Chinese women than men, whereas the odds are higher for older US women. Moreover, non-white elders in the United States have significantly lower odds of healthy ageing than their white counterparts. These findings suggest certain similar patterns of healthy ageing across two countries, but distinct patterns do exist. Promoting gender and racial equalities in healthy ageing are crucial for Chinese and American policymakers, respectively.}, keywords = {CHARLS, China, health policy, healthy aging}, isbn = {2523-8965}, doi = {https://doi.org/10.1007/s42379-020-00071-5}, author = {Chu, Lanlan and Chen, Lu} } @inbook {Laditka2020, title = {Microsimulation of Health Expectancies, Life Course Health, and Health Policy Outcomes}, booktitle = {International Handbooks of Population: International Handbook of Health Expectancies}, volume = {9}, year = {2020}, pages = {129{\textendash}138}, publisher = {Springer International Publishing}, organization = {Springer International Publishing}, address = {Basel}, abstract = {Active life expectancy measures life expectancy and the proportions of remaining life with and without disease or disability. Microsimulation, a useful tool for life course research, estimates active life expectancy by simulating individual lifetime health biographies, where the individual{\textquoteright}s status in one or more outcomes is known for each measured unit of life. In this chapter we describe how researchers use microsimulation to study active life expectancy, focusing on research of the past 20 years. We summarize the microsimulation process. We describe how researchers model current and future population health, calculate new active life expectancy measures, and forecast effects of policy change. We illustrate the application of microsimulation to active life expectancy research with a study of interval need, a measure of need for health care and other services focused on resource use. We describe strengths of microsimulation, considerations regarding its use, and directions for future research.}, keywords = {Active life expectancy, Forecasting, Health expectancy, health policy, Population Health}, isbn = {978-3-030-37668-0}, doi = {10.1007/978-3-030-37668-0_9}, author = {Laditka, Sarah B. and Laditka, James N. and Jagger, Carol}, editor = {Jagger, Carol and Eileen M. Crimmins and Saito, Yasuhiko and De Carvalho Yokota, Renata Tiene and Van Oyen, Herman and Robine, Jean-Marie} } @article {10649, title = {Is social capital protective against hospital readmissions?}, journal = {BMC Health Services Research}, volume = {20}, year = {2020}, pages = {248}, type = {Journal}, abstract = {To evaluate the association between social capital and 30-day readmission to the hospital among Medicare beneficiaries overall, beneficiaries with dementia and related memory disorders, and beneficiaries with dual eligibility for Medicaid.}, keywords = {Aging, Cohort Analysis, health policy}, isbn = {1472-6963}, doi = {10.1186/s12913-020-05092-x}, author = {Zlotnick, Hanna and Geoffrey J Hoffman and Nuliyalu, Ushapoorna and Engler, Tedi A. and Kenneth M. Langa and Ryan, Andrew M.} } @mastersthesis {10321, title = {Effects of Financial and Non-Financial Incentives on Risky Health Behaviors and Health Outcomes}, volume = {PhD}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-05-06}, pages = {276}, school = {Indiana University}, type = {phd}, abstract = {This dissertation studies how individuals respond to the incentives in policies that aim to improve health outcomes and reduce risky behaviors. My research design exploits variation in individuals{\textquoteright} out-of-pocket (OOP) medical prices generated by large insurance expansions. In Chapter 1, I study the effect of prices on the utilization of opioids and other prescription painkillers. I find that new users have a relatively high price elasticity of demand for prescription opioids, and that consumers treat over-the-counter painkillers as substitutes for prescription painkillers. My results suggest that increasing OOP opioid prices, through formulary design or taxes, may reduce new opioid use. Chapter 2 examines whether increased access to pharmaceuticals improves elderly people{\textquoteright}s functional outcomes and reduces their dependence on long-term care. I exploit the introduction of Medicare Part D, which reduced OOP drug prices and expanded drug utilization among the elderly. I find that the policy increased seniors{\textquoteright} capacity to perform activities of daily living and reduced the amount of time spent on informal caregiving by non-elderly caregivers. Chapter 3 explores unintended effects of policies that expand prescription drug coverage. Economic theory predicts that lowering people{\textquoteright}s OOP health care costs may protect them financially from the consequences of their unhealthy behaviors. I use detailed data on individuals{\textquoteright} food consumption and find that drug coverage worsens people{\textquoteright}s diets. In Chapter 4, I exploit the Affordable Care Act (ACA) dependent coverage provision to assess the impacts of health insurance on consumption among young adults. I find that expanded insurance eligibility increased total spending, particularly in the categories of food, alcohol, and contraceptives. I provide evidence that increases in consumer purchasing power may be an important spillover effect of health insurance expansions. Chapter 5 analyzes the effects of the Medicaid expansions facilitated by the ACA on racial and ethnic disparities in cancer outcomes. We find that the Medicaid expansion had no detectable effect on cancer screenings for the overall population or for any specific race, but that the incidence of early stage diagnoses increased for Whites and by Hispanics; there was no detectable change for Blacks or other non-Hispanic races.}, keywords = {0384:Behavioral psychology, 0501:Economics, 0630:Public policy, Behavioral psychology, Economics, Health Economics, health policy, Out-of-pocket medical expenses, Psychology, Public Policy, Social Sciences}, isbn = {9781392061473}, url = {https://scholarworks.iu.edu/dspace/handle/2022/22958}, author = {Soni,Aparna} } @mastersthesis {10245, title = {Three Essays in Health Care.}, volume = {Doctor of Philosophy}, year = {2018}, month = {2018}, pages = {213}, school = {University of Michigan}, address = {Ann Arbor, MI}, abstract = {This dissertation examines two common sources of increased health care costs {\textendash} readmissions and the co-occurrence of depression among patients with diabetes. The first paper examines hospital performance in the Hospital Readmissions Reduction Program to determine whether sources of incentive heterogeneity are associated with differences in improvements over multiple years. I find that hospitals seem to be responding to the main incentive in the program, as those that performed poorly in previous years improve significantly more than hospitals that have avoided penalties. Hospitals also are making improvements in conditions that have the highest marginal benefit from better performance. Payer mix does not seem to be correlated with hospital performance over time even though the financial incentives of the program only apply to future Medicare reimbursements. In the second paper I develop a model to predict the onset of depression among individuals with diabetes. Using data from the Health and Retirement Study and the National Health and Nutrition Examination Survey, I find that gender, body-mass index, hypertension, history of stroke, history of heart disease, and duration of diabetes are significant predictors of annual depression status. I then build this depression prediction algorithm into the Michigan Model for Diabetes, an existing microsimulation model that allows users to evaluate the progression of diabetes. In the final paper, I use the modified diabetes simulation model to evaluate the cost-effectiveness of the collaborative care intervention to treat depression among patients with diabetes. Trials suggest that the collaborative care intervention, a multidisciplinary approach to address the depressive symptoms of patients, can be cost-effective in the short-term when used to treat patients with diabetes and comorbid depression. Using simulation models allows us to evaluate the long-term cost-effectiveness as well as the influence of a variety of inputs on the value of the program. Only when the utility loss associated with depression is small or the intervention effectiveness is substantially decreased does the intervention require a higher willingness-to-pay to be considered cost-effective. Otherwise, our base-case analysis and other one-way sensitivity analyses support the conclusion that this intervention is cost-effective.}, keywords = {decision modeling, depression, Diabetes, Health Care, Health Economics, health policy, hospital readmissions}, url = {https://deepblue.lib.umich.edu/handle/2027.42/144000?show=full}, author = {Anup Das} } @article {8490, title = {A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare.}, journal = {Res Aging}, volume = {39}, year = {2017}, month = {2017 09}, pages = {960-986}, abstract = {

This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008-2010 (34\% died in hospital, and 66\% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43\% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.

}, keywords = {Aged, Aged, 80 and over, Decision making, Fee-for-Service Plans, Female, health policy, Hospices, Hospital Mortality, Humans, Longitudinal Studies, Male, Medicare Part C, Terminal Care, United States}, issn = {1552-7573}, doi = {10.1177/0164027516645843}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27193048}, author = {Elizabeth Edmiston Chen and Edward Alan Miller} } @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 {7575, title = {Volunteering and hypertension risk in later life.}, journal = {J Aging Health}, volume = {23}, year = {2011}, month = {2011 Feb}, pages = {24-51}, publisher = {23}, abstract = {

OBJECTIVE: This study examined the relationship between volunteer activity and hypertension, a risk factor for cardiovascular disease, renal failure, and cognitive impairment.

METHOD: Employing data from the Health and Retirement Study, we estimated regression models of hypertension status that include volunteer activity and psychosocial and health behavior risk factors for middle-aged and older persons.

RESULTS: Multivariate analyses showed volunteers had lower hypertension risk and lower systolic and diastolic blood pressure than nonvolunteers and that a threshold effect was present, whereby a modest amount of volunteer time commitment (but not a high amount) was associated with lower risk of hypertension. We did neither find support that psychosocial and health behaviors mediated this relationship nor find support for a moderating effect of volunteering for the relationships among health behaviors and hypertension.

DISCUSSION: The results of this study indicate that research is needed to determine what mediates the relationship between volunteering and hypertension.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Confidence Intervals, Female, Health Behavior, health policy, Health Status, Humans, Hypertension, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Psychometrics, Regression Analysis, Risk Factors, Social Support, Surveys and Questionnaires, Volunteers}, issn = {1552-6887}, doi = {10.1177/0898264310388272}, author = {Jeffrey A Burr and Jane Tavares and Jan E Mutchler} } @article {7674, title = {Who pays for obesity?}, journal = {J Econ Perspect}, volume = {25}, year = {2011}, month = {2011 Winter}, pages = {139-58}, publisher = {25}, abstract = {

Adult obesity is a growing problem. From 1962 to 2006, obesity prevalence nearly tripled to 35.1 percent of adults. The rising prevalence of obesity is not limited to a particular socioeconomic group and is not unique to the United States. Should this widespread obesity epidemic be a cause for alarm? From a personal health perspective, the answer is an emphatic "yes." But when it comes to justifications of public policy for reducing obesity, the analysis becomes more complex. A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population{\textemdash}a statement which is then taken to justify public policy interventions. But the question of who pays for obesity is an empirical one, and it involves analysis of how obese people fare in labor markets and health insurance markets. We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity. In the conclusion, we offer a few thoughts about some complexities of such a justification.

}, keywords = {Adult, Cost of Illness, Financing, Personal, Health Benefit Plans, Employee, Health Care Costs, health policy, Humans, Income, Insurance Coverage, Insurance Pools, Insurance, Health, Life Expectancy, Models, Econometric, Obesity, Prevalence, Private Sector, Public Sector, Risk Adjustment, Social Control Policies, United States}, issn = {0895-3309}, doi = {10.1257/jep.25.1.139}, author = {Bhattacharya, Jay and Sood, Neeraj} } @article {7545, title = {Dental care utilization and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, note = {Manski, Richard J Moeller, John Chen, Haiyan St Clair, Patricia A Schimmel, Jody Magder, Larry Pepper, John V R01 AG026090-01A2/AG/NIA NIH HHS/United States R01 AG026090-03/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Nihms172468 J Public Health Dent. 2010 Winter;70(1):67-75.}, month = {2010 Winter}, pages = {67-75}, publisher = {70}, abstract = {

OBJECTIVE: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS).

METHODS: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate.

CONCLUSIONS: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.

}, keywords = {Aged, Confounding Factors, Epidemiologic, Dental Care, Employment, ethnicity, Female, health policy, Humans, Income, Insurance, Dental, Leisure activities, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Retirement, Socioeconomic factors, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00145.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @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 {7191, title = {Economic theory and evidence on smoking behavior of adults.}, journal = {Addiction}, volume = {103}, year = {2008}, month = {2008 Nov}, pages = {1777-85}, publisher = {103}, abstract = {

AIMS: To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework.

METHODS: A systematic review and appraisal of important theoretical and empirical economic studies on smoking.

RESULTS: There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk-tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short-term rates are higher than long-term rates for both smokers and non-smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking.

CONCLUSIONS: Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.

}, keywords = {Adult, Aged, Aged, 80 and over, Choice Behavior, Costs and Cost Analysis, health policy, Humans, Impulsive Behavior, Middle Aged, Risk Factors, Smoking, Smoking cessation, Time Factors}, issn = {1360-0443}, doi = {10.1111/j.1360-0443.2008.02329.x}, url = {http://dx.doi.org/10.1111/j.1360-0443.2008.02329.x}, author = {Frank A Sloan and Wang, Yang} } @article {7208, title = {Using subjective expectations to forecast longevity: do survey respondents know something we don{\textquoteright}t know?}, journal = {Demography}, volume = {45}, year = {2008}, month = {2008 Feb}, pages = {95-113}, publisher = {45}, abstract = {

Old-age mortality is notoriously difficult to predict because it requires not only an understanding of the process of senescence-which is influenced by genetic, environmental, and behavioral factors-but also a prediction of how these factors will evolve. In this paper I argue that individuals are uniquely qualified to predict their own mortality based on their own genetic background, as well as environmental and behavioral risk factors that are often known only to the individual. Given this private information, individuals form expectations about survival probabilities that may provide additional information to demographers and policymakers in their challenge to predict mortality. From expectations data from the 1992 Health and Retirement Study (HRS), I construct subjective, cohort life tables that are shown to predict the unusual direction of revisions to U.S. life expectancy by gender between 1992 and 2004: that is, for these cohorts, the Social Security Actuary (SSA) raised male life expectancy in 2004 and at the same lowered female life expectancy, narrowing the gender gap in longevity by 25\% over this period. Further, although the subjective life expectancies for men appear to be roughly in line with the 2004 life tables, the subjective expectations of women suggest that female life expectancies estimated by the SSA might still be on the high side.

}, keywords = {Aged, Aged, 80 and over, Aging, Data collection, Demography, Female, health policy, Humans, Life Expectancy, Life Tables, Longevity, Male, Middle Aged, Mortality, Risk Factors, Sex Factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.2008.0010}, author = {Maria Perozek} } @article {6935, title = {Health insurance coverage and mortality among the near-elderly.}, journal = {Health Aff (Millwood)}, volume = {23}, year = {2004}, month = {2004 Jul-Aug}, pages = {223-33}, publisher = {23}, abstract = {

Uninsured near-elderly people may be particularly at risk for adverse health outcomes. We compared mortality of a nationally representative cohort of insured and uninsured near-elderly people with stratification by race; income; and the presence of diabetes, hypertension, or heart disease, using propensity-score methods to adjust for numerous characteristics. Lacking health insurance was associated with substantially higher adjusted mortality among adults who were white; had low incomes; or had diabetes, hypertension, or heart disease. Expanding coverage to the near-elderly uninsured may greatly improve health outcomes for these groups.

}, keywords = {Cohort Studies, Female, health policy, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Mortality, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.23.4.223}, author = {J. Michael McWilliams and Alan M. Zaslavsky and Meara, Ellen and John Z. Ayanian} } @article {6976, title = {Informal care and health care use of older adults.}, journal = {J Health Econ}, volume = {23}, year = {2004}, month = {2004 Nov}, pages = {1159-80}, publisher = {23}, abstract = {

Informal care by adult children is a common form of long-term care for older adults and can reduce medical expenditures if it substitutes for formal care. We address how informal care by all children affects formal care, which is critically important given demographic trends and the many policies proposed to promote informal care. We examine the 1998 Health and Retirement Survey (HRS) and 1995 Asset and Health Dynamics Among the Oldest-Old Panel Survey (AHEAD) using two-part utilization models. Instrumental variables (IV) estimation controls for the simultaneity of informal and formal care. Informal care reduces home health care use and delays nursing home entry.

}, keywords = {Aged, Female, Health Care Surveys, health policy, Health Services for the Aged, Home Care Services, Home Nursing, Homes for the Aged, Humans, Male, Nursing homes, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2004.04.008}, author = {Courtney Harold Van Houtven and Edward C Norton} } @article {6726, title = {The explosion in paid home health care in the 1990s: who received the additional services?}, journal = {Med Care}, volume = {39}, year = {2001}, month = {2001 Feb}, pages = {147-57}, publisher = {39}, abstract = {

OBJECTIVE: Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services.

METHODS: The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members.

RESULTS: Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05).

CONCLUSIONS: The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Family Characteristics, Female, Financing, Government, Frail Elderly, Geriatric Assessment, Health Care Surveys, Health Expenditures, health policy, Home Care Services, Home Nursing, Humans, Longitudinal Studies, Male, Marital Status, Multivariate Analysis, Social Support, Socioeconomic factors, Surveys and Questionnaires, United States, Utilization Review}, issn = {0025-7079}, doi = {10.1097/00005650-200102000-00005}, author = {Kenneth M. Langa and M.E. Chernew and Mohammed U Kabeto and Steven J. Katz} } @article {6608, title = {Life transitions and health insurance coverage of the near elderly.}, journal = {Med Care}, volume = {36}, year = {1998}, month = {1998 Feb}, pages = {110-25}, publisher = {36}, abstract = {

OBJECTIVES: This study addresses three issues. (1) What are demographic wealth, employment, and health characteristics of near-elderly persons losing or acquiring health insurance coverage? Specifically, (2) what are the effects of life transitions, including changes in employment status, health, and marital status? (3) To what extent do public policies protect such persons against coverage loss, including various state policies recently implemented to increase access to insurance?

METHODS: The authors used the 1992 and 1994 waves of the Health and Retirement Study to analyze coverage among adults aged 51 to 64 years.

RESULTS: One in five near-elderly persons experienced a change in insurance coverage from 1992 to 1994. Yet, there was no significant change in the mix of coverage as those losing one form of coverage were replaced by others acquiring similar coverage.

CONCLUSIONS: Individuals whose health deteriorated significantly were not more likely than others to suffer a subsequent loss of coverage, due to substitution of retiree or individual coverage for those losing private coverage and acquisition of Medicaid and Medicare coverage for one in five uninsured. State policies to increase access to private health insurance generally did not prevent individuals from losing coverage or allow the uninsured to gain coverage. Major determinants of the probability of being insured were education, employment status of person and spouse, and work disability status. Other measures of health and functional status did not affect the probability of being insured, but had important impacts on the probability of having public coverage, conditional on being insured.

}, keywords = {Death, Employment, health policy, Health Services Research, Health Status Indicators, Humans, Insurance Coverage, Life Change Events, Medicaid, Medically Uninsured, Medicare, Middle Aged, Retirement, Spouses, United States}, issn = {0025-7079}, doi = {10.1097/00005650-199802000-00002}, author = {Frank A Sloan and Conover, C.J.} }