• Is the recession killing granny?

    One of the points I made as a discussant at the ASHEcon conference this year is that the factors driving health care utilization and spending among Medicare beneficiaries are likely different from those for the non-elderly. Yet few analysts of health care trends comment on or exploit those differences. (For one thing, prices are a likely driver of spending growth in the commercial market, but not for the more-price-regulated Medicare.)

    Related to this, I was prepared to blog on the new paper “Recessions and seniors’ health, health behaviors, and healthcare use: Analysis of the Medicare Current Beneficiary Survey,” by Melissa McInerney, Jennifer M. Mellor (JHE, 2012). However, why reinvent the wheel? Jason Shafrin posted on it yesterday, so go read him. The upshot is that recessions affect mortality of and utilization by the non-elderly and the elderly differently. They’re good for health of the non-elderly but bad for the elderly. Why?

    Nobody knows for sure, but we can speculate. The authors point to a shift by providers to caring for more Medicare patients when non-Medicare patients pull back on their care. That actually makes a lot of sense, and it can happen without much intention. If a doctor can only see so many patients in a year (e.g., only offer so many appointments), then as one class of patients demands fewer appointments (working-age individuals with less income or more income uncertainty in a recession), another class that has almost insatiable demand (Medicare beneficiaries) will have an easier time finding an appointment. On average, they’ll see more doctors and have more procedures than they otherwise would. Instead of waiting four weeks between visits, they’ll wait three. Every time they want to see a doctor or are amenable to getting a recommended test, they have an easier time of it. Visit density for them goes up, and maybe that extra care isn’t doing them any favors.

    We can probably speculate more, but I’ll stop here.


    • Thanks, Austin. But this is puzzling. The McInerney et al paper references 2009 Miller et al and acknowledges Miller also. Yet the 2009 paper that I have on file, Why Are Recessions Good for your Health? Understanding Pro-cyclical Mortality, on page 22 hypothesizes that higher female deaths of elderly women during economic booms are due to health care worker shortages. We know that staffing levels affect health, at least for nurses so this hypothesis is reasonable. Why wasn’t this mentioned in the referenced paper if Miller et al were in communication? Has the staffing hypothesis been dropped?

    • Follow-up:
      Searching brings up the following Dec 2011 NBER Working Paper, Stevens, Miller, et al,
      From their conclusions:
      Finally, we show that employment levels in skilled nursing facilities show statistically significant declines when the unemployment rate falls, findings that are corroborated by occupation data from the CPS. Taken together, these findings suggest that pro-cyclical mortality may involve mechanisms that have little to do with individual behavioral changes in employment or time use over the business cycle. Further, our findings provide new evidence that staffing difficulties among relatively low-skilled nursing occupations may be an important focus for efforts to improve the quality of health care.

    • Makes you wonder if lack of access is why these 2 health care puzzles exist:

      1. If you take out accidents and homicides people in the USA live longer than other industrialized countries despite people in the USA having less access to healthcare.

      2. Wealthier people live long in all countries but the decline in life expectancy with lower income is sharper in Canada than in the USA despite the fact that in the USA the poor have less access to care.

      Iatrogenic death is much to common.