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The Measurement and Evolution of Health Inequality: Evidence from the U.S. Medicare Population

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  • Jonathan Skinner
  • Weiping Zhou

Abstract

Has U.S. health care for the elderly become more equitable during the past several decades? When inequality is measured by Medicare expenditures, the answer is yes. During 1987-2001, low income households experienced an increase of 78 percent ($2624) in per capita expenditures, double the increase of 34 percent ($1214) in the highest income group. When inequality is measured by life expectancy, the answer is no. Survival for the lowest income decile grew by 0.2 years during the 1990s compared to 0.8 years in the highest income group. That the two measures deliver such discordant messages may reflect their intrinsic shortcomings; expenditures depend on preferences, health status, and prices, while outcomes are strongly affected by health behavior and past illness. We suggest a new approach to measuring inequality: the use of quality-based effective care measures. For these measures, efficacy is well proven and nearly all of the relevant population should be receiving it, regardless of health status or preferences. Using Medicare claims data matched to zip code income, we find greater use of mammography screening, diabetic eye exams, and the use of ââ blockers and reperfusion following heart attacks among higher income households, and these differences appear to be stable or growing slowly over time. In sum, the rapid relative growth in health care expenditures among low income elderly people has not translated into relative improvement either in survival or rates of effective care.

Suggested Citation

  • Jonathan Skinner & Weiping Zhou, 2004. "The Measurement and Evolution of Health Inequality: Evidence from the U.S. Medicare Population," NBER Working Papers 10842, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:10842
    Note: AG HE
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    File URL: http://www.nber.org/papers/w10842.pdf
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    References listed on IDEAS

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    1. Gabriella Berloffa & Agar Brugiavini & Dino Rizzi, 2003. "Health, Income and Inequality: Evidence from a Survey of Older Italians," Giornale degli Economisti, GDE (Giornale degli Economisti e Annali di Economia), Bocconi University, vol. 62(1), pages 35-55, April.
    2. Bhattacharya, Jay & Lakdawalla, Darius, 2006. "Does Medicare benefit the poor?," Journal of Public Economics, Elsevier, vol. 90(1-2), pages 277-292, January.
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    Cited by:

    1. Pryor, Frederic L., 2007. "The anatomy of increasing inequality of U.S. family incomes," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 36(4), pages 595-618, August.
    2. Bruce D. Meyer & James X. Sullivan, 2017. "Consumption and income inequality in the US since the 1960s," AEI Economics Working Papers 953873, American Enterprise Institute.
    3. Sandra L. Decker, 2005. "Medicare and the Health of Women with Breast Cancer," Journal of Human Resources, University of Wisconsin Press, vol. 40(4), pages 948-968.
    4. Kadiyala Srikanth & Strumpf Erin, 2016. "How Effective is Population-Based Cancer Screening? Regression Discontinuity Estimates from the US Guideline Screening Initiation Ages," Forum for Health Economics & Policy, De Gruyter, vol. 19(1), pages 87-139, June.
    5. McClellan, Mark & Skinner, Jonathan, 2006. "The incidence of Medicare," Journal of Public Economics, Elsevier, vol. 90(1-2), pages 257-276, January.
    6. Gabriella Berloffa & Agar Brugiavini & Dino Rizzi, 2006. "Health, Welfare and Inequality," Working Papers 2006_41, Department of Economics, University of Venice "Ca' Foscari".

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I3 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty
    • J7 - Labor and Demographic Economics - - Labor Discrimination

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