Social Insurance Design and International Differences in Health at Older Ages

 描述（由申请人提供）：在类似的发达国家之间，健康结果和寿命的差异是公共卫生领域长期存在的难题。研究这些差异并确定其原因和后果对于确定哪些改革或变化可能最有可能改善美国和国外的健康结果至关重要。在这个项目中，我们问是否国际差异的成本，个人面临的， 处方药在数量上是一个重要的渠道，导致美国和其他经合组织国家之间记录的健康结果和寿命的差异。我们将重点放在美国和瑞典之间的比较。我们的项目利用了瑞典社会保险体系中的一系列自然实验，再加上无与伦比的质量管理数据，探索处方药覆盖率与几组常见慢性病结果之间的经验联系。首先，使用依赖于某些处方药覆盖范围和非线性保险合同时间表的离散变化的回归不连续设计，我们估计某些处方药的自付费用变化如何影响其治疗的健康结果。我们将估计当地平均效应和自付费用与健康结果之间联系的异质性，沿着社会-经济梯度然后，我们将使用美国和瑞典的行政保险索赔数据来记录一组选定条件下药品自付费用的差异。有了这些估计，我们将进行探索性分解分析，以确定自付药物成本的差异是否可能是美国和瑞典之间健康结果差异的重要渠道。该项目将促进我们对健康保险制度设计在疾病流行率和死亡率的国际变化中的作用的理解--这一作用具有重要的政策含义，但迄今为止尚未得到充分的探讨。

 DESCRIPTION (provided by applicant): Differences in health outcomes and longevity across similarly developed countries are long-standing puzzles in public health. Studying these differences and identifying their causes and consequences is crucial for determining what reforms or changes may have the highest potential to improve health outcomes in the US and abroad. In this project we ask whether international differences in costs that individuals face for prescription pharmaceuticals is a quantitatively important channel contributing to the disparities in health outcomes and longevity that have been documented between the US and other OECD countries. We focus on a comparison between the US and Sweden. Our project takes advantage of a series of natural experiments in the Swedish social insurance system, coupled with administrative data of unmatched quality, to explore the empirical link between prescription drug coverage and outcomes for several groups of common chronic conditions. First, using regression discontinuity designs that rely on discrete changes in coverage of some prescription drugs and non-linear insurance contract schedules, we estimate how changes in out of pocket costs for certain prescription drugs affect the health outcomes of conditions that they treat. Importantly, we will estimate both local average effects and heterogeneity in the link between out of pocket costs and health outcomes along the socio-economic gradient. We will then use US and Swedish administrative insurance claims data to document differences in out of pocket costs of pharmaceuticals for a select set of conditions. With these estimates in hand, we will conduct an exploratory decomposition analysis of whether differences in out of pocket costs of drugs may be an important channel accounting for differences in health outcomes between the US and Sweden. This project will advance our understanding of the role of health insurance system design for international variations in disease prevalence and mortality - this role has important policy implications, but has so far been underexplored.