HEALTH OUTCOMES: FACTORS THAT AFFECT HEALTH STATUS
I. Health status
A. Health outcomes study
B. Two dimensions of health
1. Duration of life
2. Quality of life
C. Measures of health status (H)
1. Mortality
a. Death rate
b. Life expectancy
2. Morbidity
a. Prevalence of disease
b. Incidence of disease
3. Quality adjusted life years
a. Life years
b. Quality of life weight
II. Factors affecting health status
A. Medical care services (M)
1. Aggregate medical care services
2. Individual medical care services
B. Biomedical research and medical technology (T)
1. New diagnostic tests and treatments
2. Lifestyle choice information
C. Socioeconomic factors (S)
D. Lifestyle factors (L)
E. Environmental factors (E)
F. Personal characteristics and genetic factors (P)
III. Methodology and design of a health outcomes study
A. Who does health outcomes studies?
B. How economists think about health outcomes
1. Health production function
a. Health as an output of a production process
b. Health-producing inputs
C. How medical researchers and epidemiologists think about health outcomes
1. Health as the outcome of a disease process
2. Risk factors
D. Objective of a health outcomes study
1. Four questions
a. Does a factor have an effect on health?
b. What is the direction of the effect?
c. What is the size of the effect?
d. What is the mechanism that produces the effect?
E. Effect of a factor
1. Independent causal effect
2. Marginal effect
3. Elasticity
4. Risk
a. Absolute risk
1. Risk of a health outcome for a single group
b. Relative risk
1. Ratio of the absolute risk of a health outcome for two groups
c. Marginal risk
1. Difference in the absolute risk of a health outcome for two groups.
d. Example: Annual mammogram women age 40 to 49
F. Three potential problems when doing a health outcomes study
1. Confounding factors
2. Reverse causation
3. Chance
a. p-value
G. Data
1. Experimental study
a. Randomized controlled experiment
1. Example of a randomized controlled experiment
2. Advantages of a randomized controlled experiment
a. Control for confounding factors
b. Elimination of reverse causation
4. Limitations of a randomized controlled experiment
a. Average causal effect
b. Too few subjects
c. Noncompliance
d. Generalization of conclusions
e. Long-term effects
f. Ethical considerations
2. Observational study
a. Cohort study
b. Correlation study
d. Regression study
3. Advantages and disadvantages of observational studies
IV. Results of health outcomes studies
A. Medical care
1. Randomized controlled experiments
a. Rand health insurance study (1970s)
2. Regression studies
a. Auster, Leveson, Sarachek (1969)
b. Hadley (1982)
c. Thornton (2002, 2011)
3. Conclusions: Flat-of-the-curve medicine
B. Biomedical research and medical technology
1. Cutler and Kadiyala (2003)
2. Conclusions: Flat-of-the curve shifts upward
C. Socioeconomic status
1. Income
a. Health-income gradient
b. Results of studies
1. Does income have a causal effect on health?
2. What is the direction and size of the effect?
3. What is the mechanism that produces the effect?
2. Education
a. Relationship between education and health
b. Results of studies
1. Does education have a causal effect on health?
2. What is the direction and size of the effect?
3. What is the mechanism that produces the effect?
D. Occupation/social rank
a. Relationship between social rank and health
b. Results of studies
1. Does social rank have a causal effect on health?
2. What is the direction and size of the effect?
3. What is the mechanism that produces the effect?
c. Whitehall studies
E. Lifestyle factors
1. Cigarette consumption
2. Alcohol consumption
3. Body weight
4. Exercise
5. Diet
V. Conclusions of health outcomes studies
A. General conclusions
B. Policy implications
C. Social welfare implications