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

In: Perspectives on the Economics of Aging

Author

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

Abstract

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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Suggested Citation

  • Victor R. Fuchs & Mark B. McClellan & Jonathan S. Skinner, 2004. "Area Differences in Utilization of Medical Care and Mortality among U.S. Elderly," NBER Chapters,in: Perspectives on the Economics of Aging, pages 367-414 National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberch:10349
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    References listed on IDEAS

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    1. 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.
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    5. 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.
    6. Lin, Ge, 2000. "Regional assessment of elderly disability in the U.S," Social Science & Medicine, Elsevier, vol. 50(7-8), pages 1015-1024, April.
    7. 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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    9. 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.
    10. Skinner, Jonathan & Fisher, Elliott, 1997. "Regional Disparities in Medicare Expenditures: An Opportunity for Reform," National Tax Journal, National Tax Association;National Tax Journal, vol. 50(3), pages 413-425, September.
    11. 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.
    12. Daniel P. Kessler & Mark B. McClellan, 1999. "Is Hospital Competition Socially Wasteful?," NBER Working Papers 7266, National Bureau of Economic Research, Inc.
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    Citations

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    Cited by:

    1. Deaton, Angus & Lubotsky, Darren, 2003. "Mortality, inequality and race in American cities and states," Social Science & Medicine, Elsevier, vol. 56(6), pages 1139-1153, March.
    2. Angus Deaton, 2003. "Health, Inequality, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 41(1), pages 113-158, March.
    3. Arrieta, Alejandro, 2007. "A Structural Misclassifcation Model to Estimate the Impact of Physician Incentives on Healthcare Utilization," MPRA Paper 6718, University Library of Munich, Germany.
    4. Gowrisankaran Gautam & Town Robert & Barrette Eric, 2011. "Managed Care, Drug Benefits and Mortality: An Analysis of the Elderly," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(2), pages 1-32, January.
    5. repec:pri:rpdevs:deaton_lubotsky_mortality_inequality_and_race_in_american_cities_and_stat is not listed on IDEAS
    6. 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.
    7. Do, D. Phuong & Finch, Brian Karl & Basurto-Davila, Ricardo & Bird, Chloe & Escarce, Jose & Lurie, Nicole, 2008. "Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/white health gap in the United States," Social Science & Medicine, Elsevier, vol. 67(8), pages 1258-1268, October.
    8. Tullio Jappelli & Luigi Pistaferri & Guglielmo Weber, 2004. "Health Care Quality and Economic Inequality," CSEF Working Papers 120, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    9. Marc Saez & Carme Saurina & Germà Coenders & Sònia González-Raya, 2006. "Use of primary health care services according to the different degrees of obesity in the Girona Health Region, Spain," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 173-193.
    10. Dunn, Abe & Shapiro, Adam Hale & Liebman, Eli, 2013. "Geographic variation in commercial medical-care expenditures: A framework for decomposing price and utilization," Journal of Health Economics, Elsevier, vol. 32(6), pages 1153-1165.

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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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