The relentless increase in medical care costs in the past half century has fueled intense debate over the value of medical care. Is it worth it for the United States to spend so much on medical care? What could we do to increase the benefits of medical spending relative to the costs? Debate about these issues has been hampered by the lack of good information on the benefits of medical care, and particularly, the link between individual components of medical spending and resulting health improvements. This proposal rests on the fundamental assumption that productivity improvement in medical care can be most effectively achieved by measuring systematically and jointly both the benefits and the costs of medical care, and then comparing the two. We term this National Health Accounts;forming such accounts is the overarching goal of this project. 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. We propose to realize these goals with five specific 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;(3), (4), and (5) undertaking detailed study of the costs and benefits of medical interventions in the care of three common conditions in the elderly: cardiovascular disease (including both heart disease and stroke);cancer (lung, colorectal, and breast);and depression. This proposal and its resulting products have dual ends - to further academic inquiry relating to health system value and to orient public policy. We will work with leading academics and members of government agencies to reach both goals. Establishment of a set of national health accounts will allow us as a society to understand which medical interventions improve the health of the U.S. population most efficiently.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
5P01AG031098-05
Application #
8423010
Study Section
Special Emphasis Panel (ZAG1-ZIJ-1 (O1))
Program Officer
Baker, Colin S
Project Start
2009-02-01
Project End
2015-01-31
Budget Start
2013-02-01
Budget End
2015-01-31
Support Year
5
Fiscal Year
2013
Total Cost
$1,740,921
Indirect Cost
$184,013
Name
National Bureau of Economic Research
Department
Type
DUNS #
054552435
City
Cambridge
State
MA
Country
United States
Zip Code
02138
Clemens, Jeffrey; Gottlieb, Joshua D (2014) Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health? Am Econ Rev 104:1320-1349
Fang, Margaret C; Coca Perraillon, Marcelo; Ghosh, Kaushik et al. (2014) Trends in stroke rates, risk, and outcomes in the United States, 1988 to 2008. Am J Med 127:608-15
Wilson, Michael; Cutler, David (2014) Emergency department profits are likely to continue as the Affordable Care Act expands coverage. Health Aff (Millwood) 33:792-9
Stewart, Susan T; Cutler, David M; Rosen, Allison B (2014) Comparison of trends in US health-related quality of life over the 2000s using the SF-6D, HALex, EQ-5D, and EQ-5D visual analog scale versus a broader set of symptoms and impairments. Med Care 52:1010-6
(2014) Regional variation in health care: physician beliefs or patient preferences? Natl Bur Econ Res Bull Aging Health :2-3
Wilson, Michael; Welch, Jonathan; Schuur, Jeremiah et al. (2014) Hospital and emergency department factors associated with variations in missed diagnosis and costs for patients age 65 years and older with acute myocardial infarction who present to emergency departments. Acad Emerg Med 21:1101-8
Nicholas, Lauren H; Bynum, Julie P W; Iwashyna, Theodore J et al. (2014) Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia. Health Aff (Millwood) 33:667-74
Gutman, Roee; Afendulis, Christopher C; Zaslavsky, Alan M (2013) A Bayesian Procedure for File Linking to Analyze End-of-Life Medical Costs. J Am Stat Assoc 108:34-47
Rosen, Allison B; Aizcorbe, Ana; Ryu, Alexander J et al. (2013) Policy makers will need a way to update bundled payments that reflects highly skewed spending growth of various care episodes. Health Aff (Millwood) 32:944-51
Stewart, Susan T; Cutler, David M; Rosen, Allison B (2013) US trends in quality-adjusted life expectancy from 1987 to 2008: combining national surveys to more broadly track the health of the nation. Am J Public Health 103:e78-87

Showing the most recent 10 out of 18 publications