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A Theory of Health Disparities and Medical Technology

Author

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  • Goldman Dana P

    () (RAND Corporation and NBER)

  • Lakdawalla Darius N.

    () (RAND Corporation and NBER)

Abstract

Better-educated people are healthier, although the sources of this relationship remain unclear. Starting with basic principles of consumer theory, we develop a model of how health disparities are determined that does not depend on the precise causal mechanism. Improvements in the productivity of health care disproportionately benefit the heaviest health care users. Since richer patients tend to use the most health care, this suggests that new technologies—by making more diseases treatable, reducing the price of health care, or improving health care productivity—could widen socioeconomic disparities in health. An exception to this rule, however, is a simplifying technology, which can contract health disparities, since richer patients are more likely to invest effort in adhering to complex treatment regimens. We present a few empirical case studies to help illustrate the theoretical results. First, we show that a complicated treatment regimen (antiretroviral therapy for HIV) benefited well-educated patients disproportionately. In contrast, simplifying drugs for hypertension coincided with a contraction in cardiovascular disparities not seen in other diseases. Finally, nationally representative data suggest that there are wider disparities by education among the chronically ill populations—precisely the population one would expect to be the heaviest health care users.

Suggested Citation

  • Goldman Dana P & Lakdawalla Darius N., 2005. "A Theory of Health Disparities and Medical Technology," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 4(1), pages 1-32, September.
  • Handle: RePEc:bpj:bejeap:v:contributions.4:y:2005:i:1:n:8
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    Citations

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    Cited by:

    1. Anderberg, Dan & Chevalier, Arnaud & Wadsworth, Jonathan, 2011. "Anatomy of a health scare: Education, income and the MMR controversy in the UK," Journal of Health Economics, Elsevier, vol. 30(3), pages 515-530, May.
    2. Cutler, David M. & Lleras-Muney, Adriana, 2010. "Understanding differences in health behaviors by education," Journal of Health Economics, Elsevier, vol. 29(1), pages 1-28, January.
    3. Govert e. Bijwaard & Hans Van Kippersluis, 2016. "Efficiency of Health Investment: Education or Intelligence?," Health Economics, John Wiley & Sons, Ltd., vol. 25(9), pages 1056-1072, September.
    4. McCabe, Katharine, 2016. "Mothercraft: Birth work and the making of neoliberal mothers," Social Science & Medicine, Elsevier, vol. 162(C), pages 177-184.
    5. Pinka Chatterji & Heesoo Joo & Kajal Lahiri, 2010. "Beware of Unawareness: Racial/Ethnic Disparities in Awareness of Chronic Diseases," NBER Working Papers 16578, National Bureau of Economic Research, Inc.
    6. Hernandez, Elaine M., 2013. "Provider and patient influences on the formation of socioeconomic health behavior disparities among pregnant women," Social Science & Medicine, Elsevier, vol. 82(C), pages 35-42.
    7. Lange, Fabian, 2011. "The role of education in complex health decisions: Evidence from cancer screening," Journal of Health Economics, Elsevier, vol. 30(1), pages 43-54, January.

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