• Reading list

    Identifying Provider Prejudice in Healthcare, by Amitabh Chandra, Douglas O. Staiger

    We use simple economic insights to develop a framework for distinguishing between prejudice and statistical discrimination using observational data. We focus our inquiry on the enormous literature in healthcare where treatment disparities by race and gender are not explained by access, preferences, or severity. But treatment disparities, by themselves, cannot distinguish between two competing views of provider behavior. Physicians may consciously or unconsciously withhold treatment from minority groups despite similar benefits (prejudice) or because race and gender are associated with lower benefit from treatment (statistical discrimination). We demonstrate that these two views can only be distinguished using data on patient outcomes: for patients with the same propensity to be treated, prejudice implies a higher return from treatment for treated minorities, while statistical discrimination implies that returns are equalized. Using data on heart attack treatments, we do not find empirical support for prejudice-based explanations. Despite receiving less treatment, women and blacks receive slightly lower benefits from treatment, perhaps due to higher stroke risk, delays in seeking care, and providers over-treating minorities due to equity and liability concerns.

    The Asset Cost of Poor health, by James M. Poterba, Steven F. Venti, David A. Wise

    This paper examines the correlation between poor health and asset accumulation for households in the first nine waves of the Health and Retirement Survey. Rather than enumerating the specific costs of poor health, such as out of pocket medical expenses or lost earnings, we estimate how the evolution of household assets is related to poor health. We construct a simple measure of health status based on the first principal component of HRS survey responses on self-reported health status, diagnoses, ADLs, IADL, and other indicators of underlying health. Our estimates suggest large and substantively important correlations between poor health and asset accumulation. We compare persons in each 1992 asset quintile who were in the top third of the 1992 distribution of latent health with those in the same 1992 asset quintile who were in the bottom third of the latent health distribution. By 2008, those in the top third of the health distribution had accumulated, on average, more than 50 percent more assets than those in the bottom third of the health distribution. This “asset cost of poor health” appears to be larger for persons with substantial 1992 asset balances than for those with lower balances.

    The Impact of Medicare Part D on Medication Treatment of Hypertension, by Yuting Zhang, Julie M. Donohue, Judith R. Lave, Walid F. Gellad.

    Objective. To evaluate Medicare Part D’s impact on use of antihypertensive medications among seniors with hypertension.

    Data Sources. Medicare-Advantage plan pharmacy data from January 1, 2004 to December 12, 2007 from three groups who before enrolling in Part D had no or limited drug benefits, and a comparison group with stable employer-based coverage.

    Study Design. Pre–post intervention with a comparison group design was used to study likelihood of use, daily counts, and substitutions between angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers (ARBs).

    Principal Findings. Antihypertensive use increased most among those without prior drug coverage: likelihood of use increased (odds ratio=1.40, 95 percent confidence interval [CI] 1.25–1.56), and daily counts increased 0.29 (95 percent CI 0.24–0.33). Proportion using ARBs increased from 40 to 46 percent.

    Conclusions. Part D was associated with increased antihypertensive use and use of ARBs over less expensive alternatives.

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    • re: the Medicare Part D paper; I wouldn’t give all the credit to the patients being now enrolled in a plan with meds. I’d also give some of that credit to the aggressiveness with which Medicare Advantage plans push beta blockers and hypertension disease management due to NCQA requirements. I don’t have access to the whole article but NCQA should get a hat tip here for that result.