Forum for Health Economics and Policy最新文献

As the tax base for traditional tobacco excise taxes continues to erode, policymakers have growing interest to expand taxation to novel and reduced-risk tobacco products. Chief among the latter are electronic nicotine delivery systems (ENDS; commonly known as e-cigarettes), although other reduced-risk tobacco products such as heated tobacco and smokeless tobacco products are also being considered for taxation. There are many possible rationales for taxing such products: to raise revenue, to correct for health externalities, to improve public health, to correct for internalities caused by irrationality or misinformation, and to redistribute income. Although each rationale leads to a different objective function, the conclusions regarding relative tax rates are largely the same. The relatively higher price elasticity of demand for e-cigarettes (compared to cigarettes) and the lower marginal harms from use imply in each case that taxes on e-cigarettes and other harm-reduced products should be relatively lower, and likely much lower, than those on cigarettes. Additional considerations concerning the policy goal of discouraging use of any tobacco product by youth are discussed as well.

This research examines the mental health inequalities between employed and unemployed individuals among the fluctuations over the business cycle. To analyze whether a recession affects self-evaluated mental health and consequently increases the demand for mental health care, I exploit the sudden increase of the unemployment rate in Spain during the period 2007-2009. First, I analyze the impairment of self-evaluated mental health as a consequence of the Great Recession and if it prevails during the economic recovery. In addition, I estimate if the effect on self-reported mental health is reflected in demand for mental health care. The results from an event study design show that the economic downturn increases the differences between employed and unemployed individuals in self-evaluated mental health. However, and despite the continuous improvement in unemployment, the mental health gap remained unchanged between 2014 and 2017, which could imply the persistence of some lasting impacts of the Great Recession on mental health. Nonetheless, I find a reduction in the differences of using drugs related to mental health during the period 2011-2012, when I estimate the largest inequalities in self-evaluated mental health.

In recent years, Medicare margins of U.S. short-term acute care hospitals participating in the inpatient prospective payment system (IPPS) have declined nationally by over 10 percentage points, from 2.2% in 2002 to -8.7% in 2019. This trend conceals critical regional variations, with recent studies documenting particularly low and negative margins in metropolitan areas with higher labor costs despite geographic adjustments by the Centers for Medicare & Medicaid Services (CMS). In this article, we describe recent trends in California hospitals' traditional fee-for-service Medicare operating margins compared to hospital operating margins across payers and changes in the CMS hospital wage index (HWI) used to adjust Medicare payments. We conduct an observational study of audited financial reports of IPPS-participating California hospitals using California Department of Health Care Access and Information and CMS data for years 2005-2020 (n = 4429 reports included in the analysis). We describe trends in financial measures by payer and investigate associations between HWI and traditional Medicare margins, focusing on the pre-COVID period of 2005 through 2019. During that period, California hospitals' statewide traditional Medicare operating margin declined from -27 to -40%, and financial shortfalls in caring for fee-for-service Medicare patients more than doubled ($4.1 billion in 2005 to $8.5 billion in 2019, both values in 2019 dollars). Meanwhile, operating margins from commercial managed care patients increased from 21% in 2005 to 38% in 2019. There was a stable negative association between HWI and traditional Medicare operating margins throughout the period (p = 0.000 in 2005; p < 0.0001 in 2006-2020), indicating that areas of California with higher health care wages had persistently worse traditional Medicare operating margins than areas with lower wages.

The aim of this paper is to evaluate the utility of the Health and Retirement Study (HRS) for studying the impact of working conditions on individuals' health, well-being and labor supply decisions at older ages. I provide a brief overview of the information on working conditions that is currently available in the HRS and discuss implications for studies on the effects of working conditions on the individual life course. I conclude with a discussion of how recent and projected trends in the U.S. workforce are reflected in the current HRS survey content.

In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer's disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of the HCAP demonstrated the feasibility and value of the more detailed cognitive assessments in the HCAP compared to the brief cognitive assessments in the core HRS interviews. To achieve its full potential, we provide eight recommendations for improving future iterations of the HCAP. Our highest priority recommendation is to increase the representation of historically marginalized racial/ethnic groups disproportionately affected by ADRDs. Additional recommendations relate to the timing of the HCAP assessments; clinical and biomarker validation data, including to improve cross-national comparisons; dropping lower performing items; enhanced documentation; and the addition of measures related to caregiver impact. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions.

The Health and Retirement Study is an amazing resource for those studying aging in the United States, and a fantastic model for other countries who have created similar longitudinal studies. The raw amount of information, from data on income, wealth, and use of health services to employment, retirement, and family connections on to the collection of clinical biomarkers can be both empowering and overwhelming to a researcher. Luckily through the process of engagement with the research community and constant improvement, these reams of data are not only consistently growing in a thoughtful and focused direction, they are also explained and summarized to increase the ease of use for all. One of the very useful areas of the HRS is the Contextual Data File (CDF), which is the focus of this review. The CDF provides access to easy-to-use helpful community-level data in a secure environment that has allowed researchers to answer questions that would have otherwise been difficult or impossible to tackle. The current CDF includes data in six categories (University of Michigan Institute for Social Research. 2017. HRS Data Book: The Health and Retirement Study: Aging in the 21st Century, Challenges and Opportunities for Americans. Ann Arbor: University of Michigan. Also available at https://hrs.isr.umich.edu/about/data-book, 17): 1. Socio-economic Status and Demographic Structure 2. Psychosocial Stressors 3. Health Care 4. Physical Hazards 5. Amenities 6. Land Use and the Built Environment. Each of these areas have allowed researchers to answer interesting questions such as what is the impact of air pollution on cognition in older adults (Ailshire, J., and K. M. Walsemann. 2021. "Education Differences in the Adverse Impact of PM 2.5 on Incident Cognitive Impairment Among U.S. Older Adults." Journal of Alzheimer's Disease 79 (2): 615-25), the impact of neighborhood characteristics on obesity in older adults (Grafova, I. B., V. A. Freedman, R. Kumar, and J. Rogowski. 2008. "Neighborhoods and Obesity in Later Life." American Journal of Public Health 98: 2065-71), or even what do we gain from introducing contextual data to a survey analysis (Wilkinson, L. R., K. F. Ferraro, and B. R. Kemp. 2017. "Contextualization of Survey Data: What Do We Gain and Does it Matter?" Research in Human Development 14 (3): 234-52)? My review focuses on the potential to expand contextual data in a few of these areas. From new data sets developed and released by the U.S. Census Bureau, to improved measurements of climate and environmental risk, there are numerous new data sources that would be a boon to the research community if they were joined together with the HRS. The following section begins by breaking down the opportunity provided by community or place-based data before moving on to specific recommendations for new data that could be included in the HRS contextual data file.

A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) highlights rising rates of working-age mortality in the United States, portending troubling population health trends for this group as they age. The Health and Retirement Study (HRS) is an invaluable resource for researchers studying health and aging dynamics among Americans ages 50 and above and has strong potential to be used by researchers to provide insights about the drivers of rising U.S. mortality rates. This paper assesses the strengths and limitations of HRS data for identifying drivers of rising mortality rates in the U.S. and provides recommendations to enhance the utility of the HRS in this regard. Among our many recommendations, we encourage the HRS to prioritize the following: link cause of death information to respondents; reduce the age of eligibility for inclusion in the sample; increase the rural sample size; enhance the existing HRS Contextual Data Resource by incorporating longitudinal measures of structural determinants of health; develop additional data linkages to capture residential settings and characteristics across the life course; and add measures that capture drug use, gun ownership, and social media use.

Selection bias is an ongoing concern in large-scale panel surveys where the cumulative effects of unit nonresponse increase at each subsequent wave of data collection. A second source of selection bias in panel studies is the inability to link respondents to supplementary administrative records, either because respondents do not consent to link or the matching algorithm fails to locate their administrative records. Both sources of selection bias can affect the validity of conclusions drawn from these data sources. In this article, I discuss recently proposed methods of reducing both sources of selection bias in panel studies, with a special emphasis on reducing selection bias in the US Health and Retirement Study.