NBER Working Papers by Louise Sheiner

In this paper, we examine the effects of likely demographic changes on medical spending for the elderly. Standard forecasts highlight the potential for greater life expectancy to increase costs: medical costs generally increase with age, and greater life expectancy means that more of the elderly will be in the older age groups. Two factors work in the other direction, however. First, increases in life expectancy mean that a smaller share of the elderly will be in the last year of life, when medical costs generally are very high. Furthermore, more of the elderly will be dying at older ages, and end-of-life costs typically decline with age at death. Second, disability rates among the surviving population have been declining in recent years by 0.5 to 1.5 percent annually. Reductions in...

We use data across states to examine the relation between HMO enrollment and medical spending. We find that increased managed care enrollment significantly reduces hospital cost growth. While some of this effect is offset by increased spending on physicians, we generally find a significant reduction in total spending as well. In analyzing the sources of hospital cost reductions, we find preliminary evidence that managed care has reduced the diffusion of medical technologies. States with high managed care enrollment were technology leaders in the early 1980s; by the early 1990s those states were only average in their acquisition of new technologies. This finding suggests managed care may have a significant effect on the long-run growth of medical spending.

This paper examines the degree to which the elderly reduce homeownership as they age, and the factors which influence this process. We find that average levels of homeownership decline significantly with age, even when cohort effects are taken into consideration, and that the amount of housing held by people near death is quite low compared to what is seen in cross sections. We estimate that 42% of households will leave behind a house when the last member dies. We also find that the degree to which households reduce homeownership between age 65 and death does not differ greatly between the upper and lower income halves of our sample; that people who do not have children reduce their homeownership more slowly than those who do; that increases in house prices in a state make it more likely t...