@article {7675, title = {Differences in health between Americans and Western Europeans: Effects on longevity and public finance.}, journal = {Soc Sci Med}, volume = {73}, year = {2011}, month = {2011 Jul}, pages = {254-63}, publisher = {73}, abstract = {

In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.

}, keywords = {Activities of Daily Living, Adult, Aged, Body Mass Index, Cross-Cultural Comparison, Disabled Persons, Europe, Female, Health Expenditures, health policy, Health Status Disparities, Health Surveys, Humans, Internationality, Life Expectancy, Male, Middle Aged, Models, Economic, Models, Statistical, Mortality, Public Health, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.05.027}, author = {Pierre-Carl Michaud and Dana P Goldman and Darius Lakdawalla and Adam Gailey and Yuhui Zheng} } @article {7537, title = {The fiscal consequences of trends in population health.(Forum: America{\textquoteright}s Looming Fiscal Crisis)}, journal = {National Tax Journal}, volume = {63}, year = {2010}, note = {Magazine/Journal Academic OneFile Gale 2011/02/17 COPYRIGHT 2010 National Tax Association}, pages = {307-330}, publisher = {63}, abstract = {The public burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy--with a concomitant decrease in the public sector{\textquoteright}s annuity burden--but these savings may be offset by worsening functional status which increases health care spending, reduces labor supply, and increases public assistance. Using a health microsimulation model we quantify the competing public finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures. We find that the trends in obesity and smoking have different fiscal consequences and that, because of its more profound effects on morbidity and health care expenditures, obesity represents a larger immediate risk from a fiscal perspective. Uncertainty in residual mortality improvements represents by far the largest risk. Keywords: disability, health care costs, social security, microsimulation JEL Codes: 110, 138, J26}, keywords = {Medicare/Medicaid/Health Insurance, Other, Public Policy}, doi = {10.2307/41791016}, author = {Dana P Goldman and Pierre-Carl Michaud and Darius Lakdawalla and Yuhui Zheng and Adam Gailey and Vaynman, Igor} } @article {5824, title = {Health and Access Effects of New Drugs: Combining Experimental and Non-Experimental Data}, year = {2010}, abstract = {We propose to combine clinical trial and estimates of behavioral responses in the population to quantify the value of new drug innovations when such values cannot be obtained by randomized experiments alone. New drugs are seen as having two distinct effects on patients. First, they can provide better outcomes for patients currently under treatment, due to better clinical efficacy. Second, they can also provide treatment access to more patients, perhaps by reducing side effects or expanding treatment. We compare these clinical and access effects using claims data, data on the arrival rate of new drugs, and the clinical trials literature on the effectiveness of these drugs. We find that the effect of new drug introductions on the number of patients treated accounts for a substantial majority of the value created by new drugs.}, keywords = {Health Conditions and Status, Healthcare, Methodology, Other}, url = {https://depot.erudit.org/bitstream/003241dd/1/CIRPEE10-38.pdf}, author = {Pierre-Carl Michaud and Darius Lakdawalla and Dana P Goldman and Sood, Neeraj and Cong, Ze} } @article {7410, title = {The benefits of risk factor prevention in Americans aged 51 years and older.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Nov}, pages = {2096-101}, publisher = {99}, abstract = {

OBJECTIVES: We assessed the potential health and economic benefits of reducing common risk factors in older Americans.

METHODS: A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project their health and medical spending in prevention scenarios for diabetes, hypertension, obesity, and smoking.

RESULTS: The gain in life span from successful treatment of a person aged 51 or 52 years for obesity would be 0.85 years; for hypertension, 2.05 years; and for diabetes, 3.17 years. A 51- or 52-year-old person who quit smoking would gain 3.44 years. Despite living longer, those successfully treated for obesity, hypertension, or diabetes would have lower lifetime medical spending, exclusive of prevention costs. Smoking cessation would lead to increased lifetime spending. We used traditional valuations for a life-year to calculate that successful treatments would be worth, per capita, $198,018 (diabetes), $137,964 (hypertension), $118,946 (smoking), and $51,750 (obesity).

CONCLUSIONS: Effective prevention could substantially improve the health of older Americans, and--despite increases in longevity--such benefits could be achieved with little or no additional lifetime medical spending.

}, keywords = {Diabetes Mellitus, Health Care Costs, health policy, Health Promotion, Humans, Hypertension, Middle Aged, Models, Biological, Models, Economic, Obesity, Quality-Adjusted Life Years, Risk Reduction Behavior, Smoking, Smoking Prevention, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.172627}, url = {http://sfx.lib.umich.edu:9003/sfx_local?sid=Entrez 3APubMedandid=pmid 3A19762651}, author = {Dana P Goldman and Yuhui Zheng and Girosi, Federico and Pierre-Carl Michaud and S Jay Olshansky and David M Cutler and John W Rowe} } @article {5772, title = {International Differences in Longevity and Health and Their Economic Consequences}, number = {15235}, year = {2009}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to 1.1 trillion in discounted total health expenditures from 2004 to 2050.}, keywords = {Cross-National, Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Public Policy}, doi = {10.3386/w15235}, author = {Pierre-Carl Michaud and Dana P Goldman and Darius Lakdawalla and Adam Gailey and Yuhui Zheng} } @article {10189, title = {On the Rise of Health Spending and Longevity}, year = {2009}, month = {12/2009}, pages = {1-50}, institution = {RAND}, address = {Santa Monica, United States}, abstract = {We use a calibrated stochastic life-cycle model of endogenous health spending, asset accumulation and retirement to investigate the causes behind the increase in health spending and life expectancy over the period 1965-2005. We estimate that technological change along with the increase in the generosity of health insurance may explain independently 53\% of the rise in health spending (insurance 29\% and technology 24\%) while income explains less than 10\%. By simultaneously occurring over this period, these changes may have lead to a {\textquotedblleft}synergy{\textquotedblright} or interaction effect which helps explain an additional 37\% increase in health spending. We estimate that technological change, taking the form of increased productivity at an annual rate of 1.8\%, explains 59\% of the rise in life expectancy at age 50 over this period while insurance and income explain less than 10\%. }, keywords = {demand for health, health spending, Insurance, Longevity, technological change}, url = {https://www.rand.org/content/dam/rand/pubs/working_papers/2010/RAND_WR722.pdf}, author = {Raquel Fonseca and Pierre-Carl Michaud and Galama, Titus and Arie Kapteyn} } @article {5727, title = {Understanding the Economic Consequences of Shifting Trends in Population Health}, number = {15231}, year = {2009}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {The public economic burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy - with a concomitant decrease in the public-sector{\textquoteright}s annuity burden - but these savings may be offset by worsening functional status, which increases health care spending, reduces labor supply, and increases public assistance. Using a microsimulation approach, we quantify the competing public-finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures (including Social Security and income assistance). Together, the reduction in smoking and the rise in obesity have increased net public-sector liabilities by $430bn, or approximately 4\% of the current debt burden. Larger effects are observed for specific public programs: annual spending is 10\% higher in the Medicaid program, and 7\% higher for Medicare.}, keywords = {Employment and Labor Force, Expectations, Health Conditions and Status, Healthcare, Methodology, Public Policy}, doi = {10.3386/w15231}, author = {Dana P Goldman and Darius Lakdawalla and Pierre-Carl Michaud and Yuhui Zheng and Adam Gailey} } @article {7417, title = {U.S. Pharmaceutical Policy In A Global Marketplace}, journal = {Health Affairs}, volume = {28}, year = {2009}, pages = {w138-w150}, publisher = {28}, abstract = {U.S. consumers generate more pharmaceutical revenue per person than Europeans do. This has led some U.S. policymakers to call for limits on U.S. pharmaceutical spending and prices. Using a microsimulation approach, we analyze the welfare impacts of lowering U.S. prices toward European levels, and how these impacts vary with key modeling assumptions. Under the assumptions most favorable to them, price controls generate modest benefits (a few thousand dollars per person). However, for the remainder of plausible assumptions, price controls generate costs that are an order of magnitude higher. In contrast, publicly financing reductions in consumer prices, without affecting manufacturer prices, delivers benefits in virtually all plausible cases.}, keywords = {Healthcare}, doi = {10.1377/hlthaff.28.1.w138}, author = {Darius Lakdawalla and Dana P Goldman and Pierre-Carl Michaud and Sood, Neeraj and Lempert, Robert and Cong, Ze and de Vries, Han and Italo Gutierrez} } @article {5726, title = {Retirement and the Demand for Health}, year = {2008}, institution = {RAND}, address = {Santa Monica, CA}, abstract = {This paper investigates the effect of allowing for endogeneous retirement in a life-cycle health production model with uncertainty. In particular, we study responses to changes in health insurance over the life-cycle and how retirement affects the price elasticity of the demand for health.}, keywords = {Event History/Life Cycle, Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, url = {https://psidonline.isr.umich.edu/Publications/Workshops/2008/LC/fonseca_psid.pdf}, author = {Raquel Fonseca and Pierre-Carl Michaud and Galama, Titus and Arie Kapteyn} }