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Area Differences in Utilization of Medical Care and Mortality Among U.S. Elderly

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  • Victor R. Fuchs
  • Mark McClellan
  • Jonathan Skinner

Abstract

This paper examines 313 U.S. areas for differences in medical care utilization and mortality of whites ages 65-84 in 1990. The variables included in the analysis are education, real income, cigarette sales, obesity, air pollution, percent black, and dummy variables for seven regions and five population size categories from MSAs over 500,000 to not in MSA. Utilization, especially inpatient care, is strongly positively related to mortality. Mortality is positively related to cigarette sales, obesity, air pollution and percent black. Utilization (especially outpatient) is significantly higher in MSAs with populations greater than 500,000. Mortality does not vary with population size, with or without controls. Florida is an outlier for both utilization (very high) and mortality (by far the lowest of any region). The puzzles of Floridian exceptionalism and the positive relation between white mortality and percent black are discussed but not resolved.

Suggested Citation

  • Victor R. Fuchs & Mark McClellan & Jonathan Skinner, 2001. "Area Differences in Utilization of Medical Care and Mortality Among U.S. Elderly," NBER Working Papers 8628, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:8628
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    2. Joseph J. Doyle, 2011. "Returns to Local-Area Health Care Spending: Evidence from Health Shocks to Patients Far from Home," American Economic Journal: Applied Economics, American Economic Association, vol. 3(3), pages 221-243, July.
    3. Arrieta, Alejandro, 2007. "A Structural Misclassifcation Model to Estimate the Impact of Physician Incentives on Healthcare Utilization," MPRA Paper 6718, University Library of Munich, Germany.
    4. Gowrisankaran Gautam & Town Robert & Barrette Eric, 2011. "Managed Care, Drug Benefits and Mortality: An Analysis of the Elderly," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(2), pages 1-32, January.
    5. Thomas Kopetsch & Hendrik Schmitz, 2014. "Regional Variation In The Utilisation Of Ambulatory Services In Germany," Health Economics, John Wiley & Sons, Ltd., vol. 23(12), pages 1481-1492, December.
    6. repec:pri:rpdevs:deaton_lubotsky_mortality_inequality_and_race_in_american_cities_and_stat is not listed on IDEAS
    7. Jonathan S. Skinner & Elliott S. Fisher & John Wennberg, 2005. "The Efficiency of Medicare," NBER Chapters, in: Analyses in the Economics of Aging, pages 129-160, National Bureau of Economic Research, Inc.
    8. Deaton, Angus & Lubotsky, Darren, 2003. "Mortality, inequality and race in American cities and states," Social Science & Medicine, Elsevier, vol. 56(6), pages 1139-1153, March.
    9. Brandon Roberts & Irving Hoch, 2009. "Malpractice litigation and medical costs in the United States," Health Economics, John Wiley & Sons, Ltd., vol. 18(12), pages 1394-1419, December.
    10. Angus Deaton, 2003. "Health, Inequality, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 41(1), pages 113-158, March.
    11. Jappelli, Tullio & Weber, Guglielmo & Pistaferri, Luigi, 2004. "Health Care Quality and Economic Inequality," CEPR Discussion Papers 4542, C.E.P.R. Discussion Papers.
    12. Dirk Göpffarth & Thomas Kopetsch & Hendrik Schmitz, 2016. "Determinants of Regional Variation in Health Expenditures in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 801-815, July.
    13. Boris Augurzky & Thomas Kopetsch & Hendrik Schmitz, 2013. "What accounts for the regional differences in the utilisation of hospitals in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(4), pages 615-627, August.
    14. Do, D. Phuong & Finch, Brian Karl & Basurto-Davila, Ricardo & Bird, Chloe & Escarce, Jose & Lurie, Nicole, 2008. "Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/white health gap in the United States," Social Science & Medicine, Elsevier, vol. 67(8), pages 1258-1268, October.
    15. Marc Saez & Carme Saurina & Germà Coenders & Sònia González‐Raya, 2006. "Use of primary health care services according to the different degrees of obesity in the Girona Health Region, Spain," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 173-193, February.
    16. Dunn, Abe & Shapiro, Adam Hale & Liebman, Eli, 2013. "Geographic variation in commercial medical-care expenditures: A framework for decomposing price and utilization," Journal of Health Economics, Elsevier, vol. 32(6), pages 1153-1165.
    17. Andrew J. Rettenmaier & Zijun Wang, 2012. "Regional variations in medical spending and utilization: a longitudinal analysis of US Medicare population," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 67-82, February.

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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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