Determinants of Elderly Health: The Role of Place-Based Factors

The current project extends the prior work documenting causal impacts of the current environment on elderly health behaviors and health to examine the causal role of one specific aspect of the current environment -- namely particular public policies -- in affecting these outcomes.

To accomplish this, the project has two specific aims. Aim 1 is to analyze the impacts of cash transfers and nutrition assistance on risky health behaviors, health-promoting behaviors, and health. Building on the work on the impact of laws limiting pill mills in reducing health-harmful risky prescription opioid use under the second renewal, we will study the causal impact of cash assistance programs and of nutrition programs for low-income elderly and nearly-elderly adults on risky health behaviors (such as risky use of prescription opioids, recreational drugs and alcohol), on health-promoting behaviors (such as medication adherence and adequate nutritional intake), and their net effect on health (e.g. mortality). We will study cash transfers arising from Supplemental Security Income (SSI) and tax rebates, and in-kind nutrition assistance from the Supplemental Nutrition Assistance Program (SNAP). We will estimate effects of individual programs and also compare effects of cash and in-kind receipt in the same population.

In Aim 2, we will analyze the impacts of home health care policies on health and health behaviors. Building on the work on the importance of post-acute nursing care for elderly health under the second renewal, we will examine the role of Medicare-financed post-acute home health care in promoting elderly health. We will analyze impacts on mortality, on the use of nursing home and of acute health care -- which serve as markers for elderly health and well-being -- and on health behaviors such as medication adherence and use of preventive care. We will estimate the effects of several different individual policies and compare effects across policies; we will also explore impacts of combining different policies.

Together, these analyses will reveal the nuanced and varied roles of several of the largest public policies directed at improving the health and well-being of the elderly.