Health economics

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Canada’s Globe and Mail newspaper has been running a series of articles on income inequality. This post presents some comments on the coverage of income inequality and health in Wealth begets health: Why universal medical care only goes so far by André Picard.

I make three points. First, that the article is much more consistent with the literature if one reads “poverty” every time the article uses the word “inequality.” Second, that the fact that income and health are correlated across people or across regions does not tell us that income causes health. And finally, that the research does suggest that decreasing poverty will increase health, but that we should not expect substantial reductions in health care expenditures as a result. I close with some notes on policy implications.

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Much has been made of a recent Gallup poll showing a majority of Americans now support marijuana legalization. But if a majority support legalization, why do politicians seem so reluctant to support drug law reform?

One explanation for this puzzle is that Americans who vote are less likely to support legalization than those who do not vote. Voters tend to be older, and possibly have other characteristics which are associated with opposition to drug policy reform.

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Suppose your health insurance becomes more generous, decreasing the proportion of the cost of care for which you are responsible. At the same time, your premium goes up to cover the extra costs faced by your insurer. In standard theory you are better off because you face less financial uncertainty, but you will also tend to consume too much health care because the price you pay is lower than the cost of your treatment. Standard theory suggests that insurance should be designed to optimally trade-off these benefits and costs. But standard theory assumes rationality: suppose instead people systematically make errors when choosing how much health care to consume. Does it make a difference to how we think about health insurance?

In a recently released NBER working paper, “Behavioral hazard in health insurance,” Katherine Baicker, Sendhil Mullainathan, and Joshua Schwartzstein consider behavioral biases that lead people to (specifically, and with loss of generality) underutilize health care. How should we think about designing health insurance in the presence of such biases?

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This post briefly surveys some of the methods and results in the literature on health and income inequality, closing with some remarks on problems with the existing literature and where future research may take us. It is not intended as anything resembling a comprehensive survey; Lynch et al (2004) provides a useful review of the empirical literature up to that time.

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Earlier this week I posted an article on the Globe’s Economy Lab blog on lifestyle and health care costs. Here’s a little more exposition on a couple of key points, phrased a little more formally.
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Antibiotic overuse causes great social harm yet is largely absent from public discussion of drug policy. There is a textbook external effect of an antibiotic prescription: the more antibiotics are used, the higher the risk we all face of resistant infections. As a result, there tends to be too much use of antibiotics. There have been ongoing efforts to reduce use of antibiotics, particularly in the context of treating respiratory infections, in part by educating GPs, the supply side of the relationship, on appropriate use.

In “Patient knowledge and antibiotic abuse: Evidence from an audit study in China” Janet Currie, Wanchuan Lin, and Wei Zhang consider the demand side of the relationship: what is the effect of patient knowledge on antibiotic use? Read the rest of this entry »

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