Saving Seniors’ Lives: Comparing the Efficiency and Equity of Medicare and the Clean Air Act

这项研究项目将研究两项公共政策的相对有效性-医疗补助支出和空气质量监管-用于降低65岁以上美国人死亡率的政策。它将通过避免过早死亡的数量、延长寿命和私人经济效益来衡量联邦医疗保险支出和环境保护局对细颗粒物空气污染监管的回报。这些指标是通过将最新的经济理论和测量方法应用于1999年至2013年期间65岁及以上美国人的数据而获得的。该研究还将研究空气质量监管如何以不同的方式影响种族、收入和性别群体。因此，这项研究提供了关于如何最好地改善美国老年人健康的信息。这一发现将使政策制定者了解用于改善老年人健康的不同公共支出的效率和公平性。研究结果还将提供关于如何调整公共支出以减少污染暴露和预期寿命方面的种族和社会经济差异的见解。这项研究的结果将有助于制定更好的政策，以全面改善美国公民的健康状况，从而促进美国的经济增长。该项目将产生对医疗保险支出的边际生存收益、长期减少细颗粒物空气污染的边际生存收益以及个人愿意为增加的生存概率买单的新估计。该项目将展示这些估计是否以及如何因年龄、性别、健康和社会经济地位而不同。计量经济学分析将使用工具变量方法来估计生存函数，该函数利用医疗方式和空气污染监管的时空差异。用于实施这一方法的数据是通过将联邦行政记录与对联邦医疗保险受益人的随机抽样调查相联系而构建的。结果将显示通过联邦医疗保险支出和控制空气污染降低死亡率的相对有效性，这些有效性指标将使用个人预期效用最大化医疗支出决策的经济模型转换为美元。这一研究项目的结果不仅将有助于提高公共政策的效率以改善健康，还将有助于将美国确立为卫生政策的全球领导者。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

This research project will study the relative effectiveness of two public policies---Medicaid expenditure and air quality regulation---used to reduce mortality among Americans over age 65. It will measure the returns to Medicare spending and Environmental Protection Agency regulation of fine particulate air pollution in terms of the number of premature deaths avoided, extension of life years, and private economic benefits. These measures are obtained by applying the latest economic theory and measurement methods to data on Americans 65 year and above over from 1999 through 2013 period. The research will also study how air quality regulation affects racial, income, and gender groups differently. This study therefore provides information on how best to improve the health of older citizens in the US. The findings will inform policy makers about the efficiency and fairness of different public expenditures used to improve the health of the elderly. The results also will yield insights on how public expenditures could be adjusted to reduce racial and socioeconomic disparities in pollution exposure and life expectancy. The results of this research will help to develop better policies to improve the health of US citizens generally and thus contribute to US’s economic growth.This project will generate novel estimates of marginal survival benefits of Medicare spending, marginal survival benefits of long-term reduction in fine particulate air pollution, and individuals’ willingness to pay for increased survival probabilities. The project will show whether and how these estimates differ by age, sex, health, and socioeconomic status. The econometric analysis will use an instrumental variable approach to estimate survival functions that leverages spatial and temporal variation in medical treatment style and regulation of air pollution. The data used to implement this approach are constructed by linking federal administrative records to surveys of a random sample of Medicare beneficiaries. The results will show the relative efficacy in reducing mortality through Medicare spending and regulating air pollution, and these efficacy measures will be converted into dollars using an economic model of individuals’ expected utility-maximizing medical spending decisions. The results of this research project will not only help improve efficiency of public policies to improve health, but it will also help to establish the USA as a global leader in health policy.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.