Susan L. Ettner

New evidence on the relationship between income and health

Using data from the National Survey of Families and Households, the Survey of Income and Program Participation, and the National Health Interview Survey, I estimate the structural impact of income on the following measures of health: self-assessed health status, work and functional limitations, bed days, average daily consumption of alcohol, and scales of depressive symptoms and alcoholic behavior. Both ordinary and IV estimates indicate that increases in income significantly improve mental and physical health but increase the prevalence of alcohol consumption. Cost-benefit analyses of government policies that may reduce disposable income should take into account potential effects on morbidity.

Socioeconomic Status and Health: A Micro-level Analysis of Exposure and Vulnerability to Daily Stressors*

This study examines the interconnections among education—as a proxy for socioeconomic status—stress, and physical and mental health by specifying differential exposure and vulnerability models using data from The National Study of Daily Experiences (N = 1,031). These daily diary data allowed assessment of the social distribution of a qualitatively different type of stressor than has previously been examined in sociological stress research—daily stressors, or hassles. Moreover, these data allowed a less biased assessment of stress exposure and a more micro-level examination of the connections between stress and health by socioeconomic status. Consistent with the broad literature describing socioeconomic inequalities in physical and mental health, the results of this study indicated that, on any given day, better-educated adults reported fewer physical symptoms and less psychological distress. Although better educated individuals reported more daily stressors, stressors reported by those with less education were more severe. Finally, neither exposure nor vulnerability explained socioeconomic differentials in daily health, but the results clearly indicate that the stressor-health association cannot be considered independent of socioeconomic status.

The Opportunity Costs of Elder Care

This study uses data from the 1987 National Survey of Families and Households to estimate the impact of caring for disabled elderly parents on the work hours of men and women. Instrumental variable techniques were used to correct for possible endogeneity bias. Work hours were consistently reduced by caregiving, although the effect was significant only for women providing care to parents residing outside the household. The magnitude of the caregiving effect was larger for women than for men and for coresidence than for non-coresidential care.

Resource utilization of patients with hypochondriacal health anxiety and somatization

Objectives.To examine the resource utilization of patients with high levels of somatization and health-related anxiety. Design.Consecutive patients on randomly chosen days completed a self-report questionnaire assessing somatization and health-related, hypochondriacal anxiety. Their medical care utilization in the year preceding and following completion of the questionnaire was obtained from an automated patient record. The utilization of patients above and below a predetermined threshold on the questionnaire was then compared. Patients and Setting. Eight hundred seventy-six patients attending a primary care clinic in a large, urban, teaching hospital. Outcome Measures. Number of ambulatory physician visits (primary care and specialist), outpatient costs (total, physician services, and laboratory procedures), proportion of patients hospitalized, and proportion of patients receiving emergency care. Results.Patients in the uppermost 14% of the clinic population on somatization and hypochondriacal health anxiety had appreciably and significantly higher utilization in the year preceding and the year following completion of the somatization questionnaire than did the rest of the patients in the clinic. After adjusting for group differences in sociodemographic characteristics and medical comorbidity, significant differences in utilization remained. In the year preceding the assessment of somatization, their adjusted total outpatient costs were

The impact of “parent care” on female labor supply decisions

1,312 (95% CI

Five-Year Impact of Quality Improvement for Depression Results of a Group-Level Randomized Controlled Trial

1154,

Adverse selection and the purchase of Medigap insurance by the elderly.

1481) versus

Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings.

954 (95% CI

The timing of preventive services for women and children: the effect of having a usual source of care.

868,

Effect of Full-Service Partnerships on Homelessness, Use and Costs of Mental Health Services, and Quality of Life Among Adults With Serious Mental Illness

1057) for the remainder of the patients and the total number of physician visits was 9.21 (95% CI 7.94, 10.40) versus 6.33 (95% CI 5.87, 6.90). In the year following the assessment of somatization, those above the threshold had adjusted total outpatient costs of