How Do the Better Educated Do It? Socioeconomic Status and the Ability to Cope with Underlying Impairment

There is a pronounced gradient in disability across socioeconomic groups, with better educated and higher income groups reporting substantially less disability. In this paper, we consider why that is the case, focusing on impairments in basic physical and cognitive aspects of living for the elderly. Our empirical work has two parts. First, we consider how much of this gradient in disability is a result of underlying differences in functioning versus the ability to cope with impairments. We show differences in functioning are the major part of the difference in disability, but both are important. Second, we consider how the better educated elderly cope with disability. Better educated people use substantially more assistive technology than the less educated and are more likely to use paid help. But use of these services is not the primary reason that the better educated are better able to cope. We conclude with thoughts about other potential factors that may explain differential coping.

The Role of Information in Medical Markets: An Analysis of Publicly Reported Outcomes in Cardiac Surgery

During the past two decades, several public and private organizations have initiated programs to report publicly on the quality of medical care provided by specific hospitals and physicians. These programs have sparked broad debate among economists and policy makers concerning whether, and to what extent, they have improved or harmed medical productivity. We take advantage of a cross-sectional time series of different hospitals to address two fundamental questions about quality reporting. First, we examine whether report cards affect the distribution of patients across hospitals. Second, we determine whether report cards lead to improved medical quality among hospitals identified as particularly bad or good performers. Our data are from the longest-standing effort to measure and report health care quality the Cardiac Surgery Reporting System (CSRS) in New York State. Using data for 1991 through 1999, we find that CSRS affected both the volume of cases and future quality at hospitals identified as poor performers. Poor performing hospitals lost relatively healthy patients to competing facilities and experienced subsequent improvements in their performance as measured by risk-adjusted mortality.

Intensive Medical Care and Cardiovascular Disease Disability Reductions

There is little empirical evidence to explain why disability declined among the elderly over the past 20 years. In this paper, we explore the role of improved medical care for cardiovascular disease on health status improvements over time. We show that the incidence of cardiovascular disease hospitalizations remained relatively constant between 1984 and 1999 at the same time that post-event survival improved and disability declined. We find that use of appropriate therapies, including pharmaceuticals such as beta-blockers, aspirin, and ace-inhibitors, and invasive procedures, explains up to 50% and 70% of the reductions in disability and death over time, respectively. Elderly patients living in regions with high use of appropriate medical therapies had better health outcomes than patients living in low-use areas. Finally, we estimate that preventing disability after an acute event can add as much as 3.7 years of quality-adjusted life expectancy, or $316,000 of value.

Clinical Pathways to Disability

This paper examines the pathways by which individuals transition from healthy to disabled. Because of the high prevalence and costs associated with disability, understanding these pathways is critical to developing interventions to prevent or minimize disability. We compare two estimates of disabling conditions: those observed in medical claims and conditions indicated by the disabled individual. A small number of conditions explain about half of incident disability: arthritis, infectious disease, dementia, heart failure, diabetes, and stroke. These conditions show up in medical claims and self reports. A large number of elderly also attribute disability to old age and various symptoms. Because so many of the most disabling conditions do not have clear medical treatments, the outlook for major reductions in disability might be limited.

Uncertainty in Lung Cancer Stage for Outcome Estimation via Set-Valued Classification

Difficulty in identifying cancer stage in health care claims data has limited oncology quality of care and health outcomes research. We fit prediction algorithms for classifying lung cancer stage into three classes (stages I/II, stage III, and stage IV) using claims data, and then demonstrate a method for incorporating the classification uncertainty in outcomes estimation. Leveraging set-valued classification and split conformal inference, we show how a fixed algorithm developed in one cohort of data may be deployed in another, while rigorously accounting for uncertainty from the initial classification step. We demonstrate this process using SEER cancer registry data linked with Medicare claims data.Comment: Code available at: https://github.com/sl-bergquist/cancer_classificatio

The Role of Information in Medical Markets: An Analysis of Publicly Reported Outcomes in Cardiac Surgery

During the past two decades, several public and private organizations have initiated programs to report publicly on the quality of medical care provided by specific hospitals and physicians. These programs have sparked broad debate among economists and policy makers concerning whether, and to what extent, they have improved or harmed medical productivity. We take advantage of a cross-sectional time series of different hospitals to address two fundamental questions about quality reporting. First, we examine whether report cards affect the distribution of patients across hospitals. Second, we determine whether report cards lead to improved medical quality among hospitals identified as particularly bad or good performers. Our data are from the longest-standing effort to measure and report health care quality the Cardiac Surgery Reporting System (CSRS) in New York State. Using data for 1991 through 1999, we find that CSRS affected both the volume of cases and future quality at hospitals identified as poor performers. Poor performing hospitals lost relatively healthy patients to competing facilities and experienced subsequent improvements in their performance as measured by risk-adjusted mortality.Economic