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Area Differences in Utilization of Medical Care and Mortality among U.S. Elderly

In: Perspectives on the Economics of Aging

  • Victor R. Fuchs
  • Mark B. McClellan
  • Jonathan S. Skinner

This paper examines 313 U.S. areas for differences in medical care utilization and mortality of whites ages 65-84 in 1990. The variables included in the analysis are education, real income, cigarette sales, obesity, air pollution, percent black, and dummy variables for seven regions and five population size categories from MSAs over 500,000 to not in MSA. Utilization, especially inpatient care, is strongly positively related to mortality. Mortality is positively related to cigarette sales, obesity, air pollution and percent black. Utilization (especially outpatient) is significantly higher in MSAs with populations greater than 500,000. Mortality does not vary with population size, with or without controls. Florida is an outlier for both utilization (very high) and mortality (by far the lowest of any region). The puzzles of Floridian exceptionalism and the positive relation between white mortality and percent black are discussed but not resolved.

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This chapter was published in:
  • David A. Wise, 2004. "Perspectives on the Economics of Aging," NBER Books, National Bureau of Economic Research, Inc, number wise04-1, October.
  • This item is provided by National Bureau of Economic Research, Inc in its series NBER Chapters with number 10349.
    Handle: RePEc:nbr:nberch:10349
    Contact details of provider: Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.
    Phone: 617-868-3900
    Web page: http://www.nber.orgEmail:


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    1. Jonathan S. Skinner & Elliott S. Fisher & John Wennberg, 2005. "The Efficiency of Medicare," NBER Chapters, in: Analyses in the Economics of Aging, pages 129-160 National Bureau of Economic Research, Inc.
    2. Folland, Sherman & Stano, Miron, 1989. "Sources of small area variations in the use of medical care," Journal of Health Economics, Elsevier, vol. 8(1), pages 85-107, March.
    3. Morris Silver, 1972. "An Econometric Analysis of Spatial Variations in Mortality Rates by Race and Sex," NBER Chapters, in: Essays in the Economics of Health and Medical Care, pages 161-227 National Bureau of Economic Research, Inc.
    4. Louise Sheiner & David M. Cutler, 1999. "The Geography of Medicare," American Economic Review, American Economic Association, vol. 89(2), pages 228-233, May.
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    6. Victor R. Fuchs, 1978. "The Supply of Surgeons and the Demand for Operations," NBER Working Papers 0236, National Bureau of Economic Research, Inc.
    7. Daniel P. Kessler & Mark B. McClellan, 1999. "Is Hospital Competition Socially Wasteful?," NBER Working Papers 7266, National Bureau of Economic Research, Inc.
    8. Skinner, Jonathan & Fisher, Elliott, 1997. "Regional Disparities in Medicare Expenditures: An Opportunity for Reform," National Tax Journal, National Tax Association, vol. 50(3), pages 413-25, September.
    9. Richard Auster & Irving Leveson & Deborah Sarachek, 1969. "The Production of Health, an Exploratory Study," Journal of Human Resources, University of Wisconsin Press, vol. 4(4), pages 411-436.
    10. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-96, December.
    11. Lin, Ge, 2000. "Regional assessment of elderly disability in the U.S," Social Science & Medicine, Elsevier, vol. 50(7-8), pages 1015-1024, April.
    12. Chappie, Mike & Lave, Lester, 1982. "The health effects of air pollution: A reanalysis," Journal of Urban Economics, Elsevier, vol. 12(3), pages 346-376, November.
    13. Wennberg, John E. & Barnes, Benjamin A. & Zubkoff, Michael, 1982. "Professional uncertainty and the problem of supplier-induced demand," Social Science & Medicine, Elsevier, vol. 16(7), pages 811-824, January.
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