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Institutional Affiliation: NBER
NBER Working Papers and Publications
|November 2018||Attributing Medical Spending to Conditions: A Comparison of Methods|
with David Cutler, Kaushik Ghosh, Irina Bondarenko, Kassandra Messer, Trivellore Raghunathan, Allison B. Rosen: w25233
Partitioning medical spending into conditions is essential to understanding the cost burden of medical care. Two broad strategies have been used to measure disease-specific spending. The first attributes each medical claim to the condition listed as its cause. The second decomposes total spending for a person over a year to the cumulative set of conditions they have. Traditionally, this has been done through regression analysis. This paper makes two contributions. First, we develop a new method to attribute spending to conditions using propensity score models. Second, we compare the claims attribution approach to the regression approach and our propensity score stratification method in a common set of beneficiaries age 65 and over drawn from the 2009 Medicare Current Beneficiary Surve...
|March 2017||Strengthening National Data to Better Measure What We Are Buying in Health Care: Reconciling National Health Expenditures with Detailed Survey Data|
with Allison B. Rosen, Kaushik Ghosh, Emily S. Pape, Marcelo Coca Perraillon, Irina Bondarenko, Kassandra L. Messer, Trivellore Raghunathan, David M. Cutler: w23290
As health care financing, organization, and delivery innovations proliferate, the need for comprehensive, detailed data on medical spending has never been more apparent. This study builds on previous work to provide a more comprehensive accounting of medical spending at the individual level than has been done in the past. We account for spending by the entire population: the civilian, non-institutionalized population that is the subject of past studies, as well as high medical spenders, the institutionalized, the incarcerated, and active-duty military personnel. We use within-imputation and other adjustments to build a micro dataset and reconcile survey data based on our estimate of medical spending to the National Health Expenditure Accounts (NHEA). The micro dataset we build can be used ...
|October 2014||The Contribution of Behavior Change and Public Health to Improved U.S. Population Health|
with David M. Cutler: w20631
Adverse behavioral risk factors contribute to a large share of deaths. We examine the effects on life expectancy (LE) and quality-adjusted life expectancy (QALE) of changes in six major behavioral risk factors over the 1960-2010 period: smoking, obesity, heavy alcohol use, and unsafe use of motor vehicles, firearms, and poisonous substances. These risk factors have moved in opposite directions. Reduced smoking, safer driving and cars, and reduced heavy alcohol use have led to health improvements, which we estimate at 1.82 years of quality-adjusted life. However, these were roughly offset by increased obesity, greater firearm deaths, and increased deaths from poisonous substances, which together reduced quality-adjusted life expectancy by 1.77 years. We model the hypothetical effects of a ...
|May 2005||A Proposed Method for Monitoring U.S. Population Health: Linking Symptoms, Impairments, and Health Ratings|
with Rebecca M. Woodward, Allison B. Rosen, David M. Cutler: w11358
We propose a method of quantifying non-fatal health on a 0-1 QALY scale that details the impact of specific symptoms and impairments and is not based on ratings of counterfactual scenarios. Measures of general health status are regressed on health impairments and symptoms in different domains, using ordered probit and ordinary least squares regression. This yields estimates of their effects analogous to disutility weights, and accounts for complex non-additive relationships. Health measures used include self-rated health status on a 5-point scale, EuroQol 5D (EQ-5D) scores, and ratings of current health using a 0-100 rating scale and a time-tradeoff. Data are from the nationally representative Medical Expenditure Panel Survey (MEPS) year 2002 (N=34,615), with validation in an independent s...