Health Risks, Health Technology, and Public Policy

美国国家科学基金会项目：economics首席研究员：Cole， harold标题：健康风险、健康技术与公共政策在美国和其他工业化国家，预期寿命一直在大幅增长。与此同时，以国内生产总值衡量，用于卫生用品支出的收入份额大幅增加，医疗用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，家庭的个人卫生投资和卫生部门企业的研发选择共同决定了卫生服务部门的长期卫生分布和技术进步速度。这些因素反过来又会影响社会收入和福利的长期增长。该理论模型和数据提供的参数被用作人工实验室，用于评估公共社会保险计划（特别是美国的社会保障和医疗保险计划）根本性改革的后果。该模型的关键新颖之处是对卫生部门技术进步的明确内生处理。根据本项目提出的假设，寿命的变化导致对保健产品的需求增加，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，从而刺激了对新的保健产品的需求，从而延长了寿命。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、健康和财富而不同，并在整个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寿命。家庭对保健服务的需求促使保健部门公司进行研发投资，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，以数字方式计算在该模型中具有内生增长和丰富家庭异质性的家庭和保健生产企业相互作用所产生的经济均衡。为了确保理论模型在微观家庭层面上准确描述现实世界的家庭行为，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控制家庭收入和健康结果的关键参数。然后，将这种经验主义的理论模型用于回答三组应用和直接与公共政策相关的问题。首先，评估该模型是否为推动分析的三个共同宏观经济事实提供了定量准确的解释：预期寿命延长、卫生支出份额上升和医疗产品相对价格上升。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老龄化的美国社会的财务可行性。最后，研究了限制保险公司对既存健康状况定价的医疗保健政策和减轻家庭健康状况变化对劳动收入影响的政策的影响。

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.