Satellite National Health Accounts
Though health expenditures in the U.S. are carefully tracked by the Centers for Medicare and Medicaid Services and the Bureau of Economic Analysis, the health outcomes associated with these expenditures are not. To address this need, our past research has developed detailed measures of population health and medical spending using existing national data, in order to systematically and jointly measure the benefits and the costs of medical care. These methods have been developed to serve as a Satellite National Health Account, enabling a better understanding of the health sector in the United States. We propose two new avenues of analysis using these tools that will greatly expand our understanding of health change in relation to costs across the U.S. population. The first is to examine health in conjunction with costs among all age groups- -including the elderly, middle-aged, young adults, and children—and among different socioeconomic groups. The second is to examine the health of those with different diseases, and understand specifically how it has changed over time in terms of the relationship of each disease to health and medical spending. A major output of the project is the production of a satellite National Health Account for the U.S. population as a whole, that gives critical information on health outcomes and medical expenditures for specific diseases over time, overall and among different sociodemographic groups.
With funding through the National Institute on Aging, the goal of this project is to measure systematically and jointly both the benefits and the costs of medical care, and then compare the two. At the broadest level, we have two specific aims:
- To measure population health alongside medical spending, and
- To consider the costs and benefits of past changes in medical technology and a range of interventions designed to improve the productivity of the medical system.
These goals involve two main research components: (1) tracking population health, including both mortality and quality of life, and decomposing health trends by symptoms and impairments, and underlying diseases; (2) tracking medical spending, with an understanding of spending growth at the disease level, and the cost of particular services; Continuing work is also undertaking detailed study of the costs and benefits of medical interventions in the care of particular medical conditions including cardiovascular disease (heart disease and stroke); cancer; and depression.
This project is supported by the National Institute on Aging under grant number R37AG047312.
David Cutler is the Otto Eckstein Professor of Applied Economics at Harvard University. His research interests include the determinants of health status and longevity, the economics of health care delivery, and health policy.
Kaushik Ghosh is a research specialist at the NBER. His work focuses on health economics and the study of health care delivery.
Trivellore Raghunathan is a professor of biostatistics at the University of Michigan School of Public Health. He specializes in statistical analysis of incomplete data, multiple imputation, Bayesian inference, design and analysis of sample surveys, small area estimation, analysis of longitudinal data, confidentiality and disclosure limitation, cardiovascular epidemiology.
Susan Stewart, a gerontologist, is a research specialist at the NBER. Her primary focus is the measurement of the output of the health care system in terms of quality-adjusted life expectancy.
Andrew Wang is a research economist at the NBER. His research interests include science, technology, innovation, and economic productivity.
This project is supported by the National Institute on Aging and the National Institutes of Health.
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CITATION: Medical Care 57(4), April 2019, pp. 262-269