• Reading list

    Does a Higher Income Have Positive Health Effects? Using the Earned Income Tax Credit to Explore the Income-Health Gradient, by Jeff Larrimore (Milbank Quarterly)

    Context: The existence of a positive relationship between income and morbidity has been well documented in the literature. But it is unclear whether the relationship is positive because increased income allows individuals to purchase more health inputs that improve their health, because healthy individuals are more productive and thus can earn higher wages in the labor market, or because a third factor is improving health and increasing income. This article explores whether increases in income improve the health of the low-income population.

    Methods: Because health status may affect income, this article uses an “instrumental variable” strategy that considers income variations over seventeen years of changes in the generosity of state and federal Earned Income Tax Credits (EITC, a measure that should be exogenous to health status). I measured health status using both the self-reported health status and the functional limitations indicated on the Survey of Income and Program Participation (SIPP), as well as the self-reported health status indicated on the March Current Population Survey (CPS).

    Findings: I found only limited support for the theory that the relationship between income and morbidity is derived from shifts in income. Although I did observe a correlation between income and self-reported health, I found no evidence that increases in income significantly improve self-reported health statuses. In addition, while increases in income appear to reduce the prevalence of hearing limitations when using corrective measures, these increases did not have a significant effect on most of the other functional limitations considered here.

    Conclusions: These findings suggest that the ability to improve short-term health outcomes through public transfer payments may be limited. However, the lifetime effects on the health of people with higher incomes would still be a valuable avenue for future research.

    Grading the New US Preventive Services Task Force Prostate Cancer Screening Recommendation, by Robert J. Volk and Andrew M. D. Wolf (Journal of the American Medical Association)

    Prostate Cancer Screening—Time to Abandon One-Size-Fits-All Approach? by Jeri Kim and John W. Davis (Journal of the American Medical Association)

    Missing the Mark on Prostate-Specific Antigen Screening, by David C. Miller and Brent K. Hollenbeck (Journal of the American Medical Association)

    Prostate Cancer Screening—The Evidence, the Recommendations, and the Clinical Implications, by Roger Chou and Michael L. LeFevre (Journal of the American Medical Association)

    Copyright and Open Access at the Bedside, by John C. Newman and Robin Feldman (New England Journal of Medicine)

    Building the Path to Accountable Care, by Elliott S. Fisher, Mark B. McClellan and Dana G. Safran (New England Journal of Medicine)

    Confirming the CMS Nominee — Overcoming Poisonous Politics, by John K. Iglehart (New England Journal of Medicine)

    Achieving Accountable Care — “It’s Not About the Bike,” by James Walker and Aaron McKethan (New England Journal of Medicine)

    Reversals of Established Medical Practices: Evidence to Abandon Ship, by Vinay Prasad, Adam Cifu and John P. A. Ioannidis (Journal of the American Medical Association)

    Where Are the Health Care Cost Savings? by Ezekiel J. Emanuel (Journal of the American Medical Association)

    Two Years and Counting: How Will the Effects of the Affordable Care Act Be Monitored? by Robert H. Brook (Journal of the American Medical Association)

    Withholds to Slow Medicare Spending: A Better Deal Than Cuts, by Jonathan S. Skinner, James N. Weinstein and Elliott S. Fisher (Journal of the American Medical Association)

    A Tale of Coronary Artery Disease and Myocardial Infarction, by Elizabeth G. Nabel and Eugene Braunwald (New England Journal of Medicine)

    • It’s fascinating to learn that there are highly educated people involved in public health research who think it’s worthwhile to treat income as an exogenous variable that has little or no causal association with other personal attributes that affect personal health.

    • That is a very interesting finding thank you for posting it. That is evidence that though health correlates with income, income is not causal. It is evidence that something else is causing low income and poor health. Poor health could easily cause lower income. We need a good test of that because for example poor impulse control could cause both bad heath and low income. Highly talented athletes could be a place to look. Athletics does not require a lot on impulse control.

      It is my observation that a large amount of money can be destructive to some people’s health e.g. it allows some people to drink all day and drug all night and drive very fast care very fast. BTW the is a section Of Glasgow Scotland where male life expectancy is below 55 years. Those people might be drinking themselves to death. Giving them free stuff (including free health care) might just speed up the process.

    • Very interesting piece by Larimore. However, I’d guess that self-reported health status and functional limitations (difficulty performing activities of daily living, most likely) are rather gross measures of poor health.

      We normally ask people if their health is excellent, very good, good, fair or poor, and we flag people in fair or poor health – and fair/poor reported health usually does mean you’re more likely to have chronic conditions or functional impairments, but it’s not a very fine measure.

      Functional impairments in younger adults usually mean they’re severely disabled.

      That’s not necessarily Larimore’s fault. He’s limited by the data that the Census bureau collects. For something like what he wants to do, I would personally have tried to use number of chronic conditions diagnosed, or intensity of service utilization, in the Medical Expenditures Panel Survey. And it does appear to go back to 1996…