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The Costs and Benefits of Intensive Treatment for Cardiovascular Disease

Author

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  • David Cutler
  • Mark McClellan
  • Joseph Newhouse

Abstract

This paper examines the causes and consequences of reductions in cardiovascular disease mortality, and in particular heart attack mortality, over the past several decades. Analysis of data from Medicare and review of the clinical literature indicate that a large share of the recent decline in heart attack mortality is a result of new medical interventions and increased use of existing interventions. Much of the mortality improvement appears to be the result of changes in the use of pharmaceuticals such as aspirin and clot-busting (thrombolytic) drugs. Greater use of these and other intensive medical procedures have increased the cost of treating heart attacks but have also lead to health improvements. We estimate that the value of improved health is greater than the increased cost of heart attack care, so that the cost of living for people with a heart attack is falling. We present preliminary evidence that patients in managed care receive nearly similar treatment for heart attacks compared to patients with traditional indemnity insurance, but that managed care insurers pay less for the same treatments than do traditional insurers.

Suggested Citation

  • David Cutler & Mark McClellan & Joseph Newhouse, 1998. "The Costs and Benefits of Intensive Treatment for Cardiovascular Disease," NBER Working Papers 6514, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:6514
    Note: AG HC
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    Cited by:

    1. Robert J. Gordon, 2006. "The Boskin Commission Report: A Retrospective One Decade Later," International Productivity Monitor, Centre for the Study of Living Standards, vol. 12, pages 7-22, Spring.
    2. John A. Romley & Dana P. Goldman, 2011. "How Costly is Hospital Quality? A Revealed‐Preference Approach," Journal of Industrial Economics, Wiley Blackwell, vol. 59(4), pages 578-608, December.
    3. Adriana Lleras-Muney, 2005. "The Relationship Between Education and Adult Mortality in the United States," Review of Economic Studies, Oxford University Press, vol. 72(1), pages 189-221.
    4. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, Oxford University Press, vol. 124(2), pages 597-636.
    5. Gianluca Baio & Laura Magazzini & Claudia Oglialoro & Fabio Pammolli & Massimo Riccaboni, 2005. "Medical Devices: Competitiveness and Impact on Public Health Expenditure," Working Papers CERM 05-2005, CompetitivitĂ , Regole, Mercati (CERM).
    6. Darby, Julia & Hart, Robert A. & Vecchi, Michela, 2001. "Labour force participation and the business cycle: a comparative analysis of France, Japan, Sweden and the United States," Japan and the World Economy, Elsevier, vol. 13(2), pages 113-133, April.
    7. Dora Costa, 2000. "Understanding the twentieth-century decline in chronic conditions among older men," Demography, Springer;Population Association of America (PAA), vol. 37(1), pages 53-72, February.
    8. Cutler, David M & Epstein, Arnold M. & Frank, Richard G. & Hartman, Raymond & King, Charles III & Newhouse, Joseph P. & Rosenthal, Meredith B. & Vigdor, Elizabeth Richardson, 2000. "How Good a Deal Was the Tobacco Settlement? Assessing Payments to Massachusetts," Journal of Risk and Uncertainty, Springer, vol. 21(2-3), pages 235-261, November.
    9. Richard G. Frank & Ernst R. Berndt & Susan H. Busch, 1998. "Price Indexes for the Treatment of Depression," NBER Working Papers 6417, National Bureau of Economic Research, Inc.
    10. Dora L. Costa & Joanna Lahey, 2003. "Becoming Oldest-Old: Evidence from Historical U.S. Data," NBER Working Papers 9933, National Bureau of Economic Research, Inc.
    11. Cutler, David M. & Mas, Nuria, 2003. "Comparing non-fatal health across countries: Is the US medical system better?," IESE Research Papers D/525, IESE Business School.
    12. Laurence C. Baker & Ciaran S. Phibbs, 2000. "Managed Care, Technology Adoption, and Health Care: The Adoption of Neonatal Intensive Care," NBER Working Papers 7883, National Bureau of Economic Research, Inc.
    13. Robert J. Gordon, 2000. "The Boskin Commission Report and its Aftermath," NBER Working Papers 7759, National Bureau of Economic Research, Inc.
    14. Groot, Wim & van den Brink, Henriette Maassen, 2007. "Optimism, pessimism and the compensating income variation of cardiovascular disease: A two-tiered quality of life stochastic frontier model," Social Science & Medicine, Elsevier, vol. 65(7), pages 1479-1489, October.
    15. Jeffrey S. McCullough, 2008. "The adoption of hospital information systems," Health Economics, John Wiley & Sons, Ltd., vol. 17(5), pages 649-664.

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