Marginal Revolution: Is health care good for you after all?

November
S	M	T	W	Th	F	St
1	2	3	4	5	6	7
8	9	10	11	12	13	14
15	16	17	18	19	20	21
22	23	24	25	26	27	28
29	30

« Neglected growth miracles | Main | Who *was* Jane Galt? »

Is health care good for you after all?

This paper is very clever:

Health care spending varies widely across markets, yet there is little evidence that higher spending translates into better health outcomes, possibly due to endogeneity bias. The main innovation in this paper compares outcomes of patients who are exposed to different health care systems that were not designed for them: patients who are far from home when a health emergency strikes. The universe of emergencies in Florida from 1996-2003 is considered, and visitors who become ill in high-spending areas have significantly lower mortality rates compared to similar visitors in lower-spending areas. The results are robust across different types of patients and within groups of destinations that appear to be close demand substitutes.

Here are non-gated versions.

Posted by Tyler Cowen on August 15, 2007 at 12:11 PM in Medicine | Permalink

Comments

The universe of emergencies in Florida from 1996-2003 is considered, and visitors who become ill in high-spending areas have significantly lower mortality rates compared to similar visitors in lower-spending areas.

Uh, what? Wouldn't that signify higher spending as being *more* helpful?

Posted by: Person at Aug 15, 2007 12:19:18 PM

Doesn't this basically mean that emergency services work well?

Posted by: jb at Aug 15, 2007 12:28:57 PM

yes, i agree with JB.

This seems to indicate the effectiveness of emergency services.

and even more strongly, it indicates the ineffectiveness of preventive care/family care services/etc....

Posted by: thehova at Aug 15, 2007 1:53:48 PM

this study does appear to confirm my suspicion that my yearly physicals are useless.

Posted by: thehova at Aug 15, 2007 1:57:32 PM

The idea of the paper, what makes it clever, is the way it tries to get around endogeneity bias. Suppose town A is full of rich hypochonriacs, they spend a lot on health care to little result. Town B is full of frugal health nuts, they spend little and are ok health-wise. Simply comparing spending and outcomes is bogus if people sort like this in any significant way. Now we take people from towns A and B and randomly plop them down in State C that has some towns where spending is high (possibly because the people who live there are hypochondriacs) and some where spending is low. But the tourist people from towns A and B don't sort on State C's health care system, they just go to the closest place. This sort of semi-randomization gives the comparisons "bite".

The paper doesn't say preventive care is useless, nor does it say that emergency services work well. It does say that in this case, higher spending produces better outcomes (like Person pointed out), and it implies that studies saying otherwise need to be examined for endogeneity bias issues.

Posted by: angus at Aug 15, 2007 2:16:49 PM

i get what your saying. but still, couldn't this mean:

"...they just go to the closest place."

emergency facilities, making it not so random. or urgent care. def. not any type of preventative care or likely not family care docs. shouldn't we be open to the possibility that the effectiveness of emergency care accounts for the superior treatment of non residents at better equipped locales with state of the art emergency care facilities.

but yeah, i'm sure you pointed out what the main theme of the paper and what tyler was getting at.

Posted by: thehova at Aug 15, 2007 2:43:57 PM

"The results are robust across different types of patients and within groups of destinations that appear to be close demand substitutes."

yeah, to be honest, that line might hurt my argument.

Posted by: thehova at Aug 15, 2007 2:51:18 PM

I though, an assumption on my part, that the people who do studies like the "Eight Americas" (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030260)
would have corrected for the fact that unhealthy people would tend to move to cities from rural areas. Is there a health cost to congestion?
Other questions:
Does poverty cause bad health or bad health cause poverty. This gets complicated considering that good looks and height incease income and are signs of good health?
Does regular exercise increase health or as Dr Idell has said do healthy people just exercise more.
How well are all these studies done? Are they checking for the obvious things?

Posted by: Floccina at Aug 15, 2007 3:21:15 PM

I can't access the full-text and without that it's hard to understand the methodology. Two obvious questions, to me, are is there a difference between people who have emergencies in high-spending areas vs. those who have emergencies in low-spending areas, and are there differences between the high-spending and low-spending areas, other than the difference in spending, that can explain the difference in outcomes? If the author does examine those issues, could someone explain. Thanks.

Posted by: SteveH at Aug 16, 2007 11:04:41 AM

Posted by: sent at Aug 18, 2007 2:44:25 AM

H i B e s t w i s h e s。Allow me to offer my heartiest wishes.x i c a o l o v e s-流水线娱乐博客常年提供高、中、低压锅炉钢管、流体钢管、结构钢管、化肥专用钢管、石油裂化钢管、地质钢管、液压支柱钢管及合金钢管-无缝管-无缝钢管等论文发表资讯/刊物信息，协助客户制定论文发表方案

Posted by: 无缝管 at Nov 13, 2007 8:18:12 PM

h翻译公司|f深圳翻译good深圳翻译公司|好同声传译

Posted by: 深圳翻译公司 at Feb 13, 2008 8:35:55 AM

h翻译公司|f深圳翻译good深圳翻译公司|好同声传译

Posted by: 深圳翻译公司 at Feb 13, 2008 8:40:30 AM

徵信社
 徵信
 徵信社

Posted by: 鑽石 at Apr 2, 2008 9:48:53 PM

Marginal Revolution

Small steps toward a much better world.

Google Search

Recent Posts

Our Web Pages

Email Us

Our Guests

Archives

Blogs We Like

Resources

Interesting People and Sites

Is health care good for you after all?

Comments

Post a comment

BlogAds

Supporters

Stats