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岁以上美国人的死亡率。它将衡量医疗保险支出和环境保护局对细颗粒空气污染的监管的回报，包括避免过早死亡的数量，生命年的延长和私人经济效益。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不同地影响种族，收入和性别群体。 因此，这项研究提供了如何最好地改善美国老年人健康的信息。调查结果将告知政策制定者用于改善老年人健康的不同公共支出的效率和公平性。研究结果还将揭示如何调整公共支出，以减少污染暴露和预期寿命方面的种族和社会经济差异。 这项研究的结果将有助于制定更好的政策，以改善美国公民的健康，从而促进美国的经济增长。该项目将产生新的估计边际生存效益的医疗保险支出，边际生存效益的长期减少细颗粒空气污染，和个人的意愿支付增加生存概率。该项目将显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有所不同。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空间和时间变化。用于实施这一方法的数据是通过将联邦行政记录与对医疗保险受益人的随机抽样调查联系起来构建的。结果将显示通过医疗保险支出和调节空气污染降低死亡率的相对功效，这些功效措施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。 该研究项目的成果不仅有助于提高公共政策的效率，以改善健康，但它也将有助于建立美国作为一个全球领先的健康政策。该奖项反映了NSF的法定使命，并已被认为是值得支持的评估使用基金会的智力价值和更广泛的影响审查标准。

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.