Health Risks, Health Technology, and Public Policy

摘要提案编号：SES -1326781机构：美国国家经济研究局NSF项目：经济学首席研究员：科尔，哈罗德标题：健康风险，健康技术和公共政策在美国以及其他工业化国家，预期寿命有很大的长期增长。与此同时，以国内生产总值衡量的收入中用于卫生相关商品支出的份额大幅增加，医疗商品的相对价格一直在上涨。该项目开发了一类新的理论模型来共同解释这些观察结果，并研究它们在多大程度上受到公共政策的影响。在该模型中，家庭的个人健康投资和卫生部门企业的研发选择共同决定了长期健康分布和卫生服务部门的技术进步率。这些因素反过来又会影响社会收入和福利的长期增长。这个理论模型，并与参数通知的数据，然后被用来作为人工实验室，以评估公共社会保险计划，特别是在美国的社会保障和医疗保险计划的根本性改革的后果。该模型的一个关键的新特点是明确的内生治疗的技术进步在卫生部门。根据该项目提出的假设，寿命的变化导致对保健品的需求增加，从而将活动引向医疗部门。由此产生的针对医疗部门的技术进步产生了新的治疗方法和药物，从而刺激了对新的健康商品的需求，而这反过来又延长了寿命。这一核心机制被嵌入到一个完整的宏观经济模型中，在这个模型中，个体因年龄、收入、健康和财富而异，并在生命周期中做出医疗投资选择。这些反过来又决定了他们的健康和长寿。家庭对卫生服务的需求促使卫生部门企业进行研发投资，这反过来又决定了该部门技术进步的速度。该项目的部分产出是开发软件，以数值方式计算在具有内生增长和丰富的家庭异质性的这一模型中家庭和保健生产公司相互作用所产生的经济均衡。为了确保理论模型能够准确描述微观家庭层面的真实家庭行为，使用包含个人劳动收入和健康信息的家庭调查数据来估计决定家庭收入和健康结果的关键参数。因此，经验告知的理论模型，然后投入使用，以回答三套应用和直接的公共政策相关的问题。首先，它是评估是否该模型提供了一个定量准确的解释，为三个联合宏观经济的事实，激励分析：预期寿命延长，不断上升的医疗支出份额和较大的相对价格的医疗用品。其次，它用于评估不同的政策选择（例如增加税收，减少福利或延迟福利），以保持医疗保险和社会保障在美国老龄化社会中的财务可行性。最后，它被用来研究医疗保健政策的影响，限制保险公司和政策，减轻家庭健康状况的变化对劳动力收入的影响的定价预先存在的健康状况。

AbstractProposal No: SES - 1326781Institution: National Bureau of Economic Research Inc NSF Program: ECONOMICSPrincipal Investigator: Cole, HaroldTitle: Health Risks, Health Technology, and Public PolicyIn the U.S. as well as in other industrialized countries there has been a large secular increase in life expectancy. At the same time the share of income, measured as gross domestic product, devoted to expenditures on health-related goods has increased substantially, and the relative price of medical goods has been rising. This project develops a novel class of theoretical models to jointly explain these observations, and to study to what extent they are shaped by public policies. In the model individual health investments of households and research and development (R&D) choices of firms in the health sector jointly determine the long-run health distribution and the rate of technological progress in the health services sector. These factors in turn will shape long-run growth of incomes and welfare in society. This theoretical model, and with parameters informed by the data, is then used as artificial laboratory to evaluate the consequences of fundamental reforms in public social insurance programs, specifically the social security and Medicare programs in the U.S.A key novel feature of the model is the explicit endogenous treatment of technological progress in the health sector. According to the hypothesis advanced in this project changes in longevity lead to increased demand for health goods, which channels activity towards the medical sector. The resulting technological progress which is directed towards the medical sector yields new treatments and drugs, therefore stimulating demand for new health goods which in turn improve longevity. This core mechanism is embedded into a complete model of the macro economy in which individuals differ by age, income, health, and wealth, and make medical investment choices over the life cycle. These in turn determine their health and longevity. Household demand of health services induces R&D investments by health sector firms, which in turn determines the speed of technological progress in that sector. Part of the output from this project is the development of software that computes numerically the economic equilibrium emerging from the interaction of households and health production firms in this model with endogenous growth and rich household heterogeneity. To insure that the theoretical model delivers an accurate description of real-world household behavior on the micro household level the crucial parameters governing household earnings and health outcomes are estimated using household survey data containing information on individual labor incomes and health. The so empirically informed theoretical model is then put to use to answer three sets of applied and directly public policy relevant questions. First, it is evaluated whether the model provides a quantitatively accurate explanation for the three joint macroeconomic facts motivating the analysis: longer life expectancy, a rising health expenditure share and a larger relative price of medical goods. Second, it is used for the evaluation of different policy options (e.g. increasing taxes, reducing benefits, or delaying benefits) to keep Medicare and Social Security financially viable in an aging U.S. society. Finally, it is employed to study the impact of health care policies that limit the pricing of pre-existing health conditions by insurance companies and policies that mitigate the impact of changes in household health status on labor earnings.