W. David Bradford

The association between individual time preferences and health maintenance habits.

Context. Encouraging healthy behaviors, including disease screening, exercise, and tobacco avoidance, has been a significant focus of clinical attention in recent decades. Little is known about the association between individual preferences with respect to time play and preventive health care use and healthy lifestyles. Objective. To determine whether rates of these health behaviors are associated with latent time preferences. Design. Interval regression analysis was used to impute individual level discount rates. The difference in means for the rates of health behaviors were assessed for high vs. low to moderate discounting groups using one-factor probit models. Participants. The 2004 wave of the Health and Retirement Survey included in a time preferences module (1,039 respondents aged 24 to 65 years). Main Outcome Measures. Rates of recent mammograms, breast exams, Pap smears, prostate exams, cholesterol testing, flu shots, and dental visits, and non-smoking status. Results. Respondents in the upper 20th percentile of the distribution have an average imputed annual discount rate of 0.335 (33.5%). High discount rate status is found to have a negative marginal association on the probability that respondents had recent mammogram use (—15.1%; P = 0.001), Pap smear use (—8.3%; P = 0.049), prostate examination use (—20.4%; P =0.003), dental visits (—24.8%; P = 0.001), cholesterol testing (—12.4%; P = 0.001), flu shot usage (—11.1%; P = 0.005), rates of vigorous exercise (—15.1%; P = 0.001), nonsmoking status (—10.4%; P= 0.001), and undertook all measured health habits (—7%; P = 0.001). Conclusions. Differences in underlying preferences for the present over the future may be a substantial barrier for people’s propensity to adopt healthy lifestyles.

Relative inefficiencies in production between solo and group practice physicians

Health economists have hypothesized for some time that physicians produce medical care in an inefficient manner. Further, whether solo or group practice physicians are relatively more inefficient has been a question of particular interest. Theoretical considerations suggest that solo and group practice physicians face different behavioural and production constraints, implying that they may produce care at different levels of efficiency; which is more efficient is an empirical question. We employed stochastic production frontier estimation to address this issue.

Stochastic Frontier Estimation Of Cost Models Within The Hospital

Assessing the impact of new technologies on health care costs is an important research area. This paper evaluates two technologies used to treat coronary artery disease. We estimate two separate stochastic frontier modelsone for balloon angioplasty patients and one for cardiac bypass surgery patientusing data taken from detailed chart and cost files of a large urban hospital. Cost estimates for the two technologies are purged of inefficiency so that forecasts of the cost consequences of technology shift can be based on best-practice production techniques. Learning behavior, physician effects, and patient clinical characteristics are also taken into account. We find that there are potential cost savings associated with making angioplasty a more perfect substitute for bypass surgery, as well as current inefficiency in production.

Getting used to it: The adaptive global utility model

This paper expands the standard model of utility maximization to endogenize the ubiquitous phenomenon of adaptation. We assume that total utility is an aggregate function of the utility associated with different domains of life, with relative weights that are optimized according to the effort that the individual expends on producing utility in each domain. Comparative statics from the general maximization problem demonstrate that the traditional Slutsky equation should incorporate an additional response term to account for adaptation processes. Our adaptive global utility maximization model can be used to explain responses to changes in health.

Some State Vaccination Laws Contribute To Greater Exemption Rates And Disease Outbreaks In The United States

Health officials attest that immunizations are among the most successful interventions in public health. However, there remains a substantial unvaccinated population in the United States. We analyzed how state-level vaccination exemption laws affect immunization rates and the incidence of preventable disease. We measured the association between each component of state kindergarten vaccination exemption laws and state vaccination exemption rates from 2002 to 2012, using the Centers for Disease Control and Preventions annual school assessment reports. We found that policies such as requiring health department approval of nonmedical exemptions, requiring a physician to sign an exemption application, and having criminal or civil punishments for noncompliance with immunization requirements had a significant effect in reducing vaccine exemptions. Our exemption law effectiveness index identified eighteen states with the most effective laws and nine states with the least effective ones. The most effective states had lower incidences of pertussis, compared to other states. For policy makers interested in decreasing the number of vaccine exemptions in their state, our findings are of particular interest.

Task Force #2—the cost of prevention: can we afford it? Can we afford not to do it?

The development of many strategies for the prevention of cardiovascular disease (CVD) presents an important policy question for society: do the benefits of these programs and interventions justify the investment in them? Preventive strategies may provide attractive opportunities to avoid or defer

Money Matters: Cost-Effectiveness of Juvenile Drug Court with and without Evidence-Based Treatments

The 12-month cost-effectiveness of juvenile drug court and evidence-based treatments within court were compared with traditional Family Court for 128 substance-abusing/dependent juvenile offenders participating in a 4-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost-effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes.

Continuity of medical care, health insurance, and nonmedical advice in the first 3 years of life.

ObjectivesThe study seeks to evaluate whether continuity in medical care provides a mechanism that contributes to increased parental awareness of the importance of dental services, nutrition, and child development and whether health insurance encourages such continuity. MethodsData pertaining to medical utilization and dental, child nutrition, and child development counseling were extracted from the National Maternal and Infant Health Survey, 1988 and the 1991 Longitudinal Follow-up. These data permit the investigation of whether having continuity in medical care for a child increases the likelihood that the child’s parent receives advice about dental health, nutrition, and child development. Restricting the analyses to Caucasian and African American women and excluding respondents with missing information on the child’s health care utilization yielded 7056 participants. We created a set of binomial logit models, with correction for clustering (due to sample design). These models jointly estimate the likelihood that a child was classified as having continuity of care and the likelihood that the child’s mother received advice about the 3 areas of interest. ResultsPrivate fee-for-service health insurance was found to increase the likelihood that a child receives continuity of care. When primary care was provided with high continuity of care, the probability that physicians provide mothers with dental, nutritional, and developmental advice was increased. ConclusionsThese results suggest that continuity of care may have important spillover effects beyond direct medical care by improving maternal information about child dental care, nutrition, and developmental issues.

A PRESCRIPTION FOR UNEMPLOYMENT? RECESSIONS AND THE DEMAND FOR MENTAL HEALTH DRUGS

We estimate the relationship between mental health drug prescriptions and the level of labor market activity in the USA. Based on monthly data from the National Ambulatory Medical Care Survey of physicians and aggregated by US census regions, we find that the number of mental health drug prescriptions (those aimed at alleviating depression and anxiety) rises by about 10% when employment falls by 1% and when unemployment rises by 100 basis points, but only for patients in the Northeast region. This paper is one of the first to look at compensatory health behavior in response to the business cycle.

Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population

Importance Opioid-related mortality increased by 15.6% from 2014 to 2015 and increased almost 320% between 2000 and 2015. Recent research finds that the use of all pain medications (opioid and nonopioid collectively) decreases in Medicare Part D and Medicaid populations when states approve medical cannabis laws (MCLs). The association between MCLs and opioid prescriptions is not well understood. Objective To examine the association between prescribing patterns for opioids in Medicare Part D and the implementation of state MCLs. Design, Setting, and Participants Longitudinal analysis of the daily doses of opioids filled in Medicare Part D for all opioids as a group and for categories of opioids by state and state-level MCLs from 2010 through 2015. Separate models were estimated first for whether the state had implemented any MCL and second for whether a state had implemented either a dispensary-based or a home cultivation only–based MCL. Main Outcomes and Measures The primary outcome measure was the total number of daily opioid doses prescribed (in millions) in each US state for all opioids. The secondary analysis examined the association between MCLs separately by opioid class. Results From 2010 to 2015 there were 23.08 million daily doses of any opioid dispensed per year in the average state under Medicare Part D. Multiple regression analysis results found that patients filled fewer daily doses of any opioid in states with an MCL. The associations between MCLs and any opioid prescribing were statistically significant when we took the type of MCL into account: states with active dispensaries saw 3.742 million fewer daily doses filled (95% CI, −6.289 to −1.194); states with home cultivation only MCLs saw 1.792 million fewer filled daily doses (95% CI, −3.532 to −0.052). Results varied by type of opioid, with statistically significant estimated negative associations observed for hydrocodone and morphine. Hydrocodone use decreased by 2.320 million daily doses (or 17.4%) filled with dispensary-based MCLs (95% CI, −3.782 to −0.859; P = .002) and decreased by 1.256 million daily doses (or 9.4%) filled with home-cultivation–only-based MCLs (95% CI, −2.319 to −0.193; P = .02). Morphine use decreased by 0.361 million daily doses (or 20.7%) filled with dispensary-based MCLs (95% CI, −0.718 to −0.005; P = .047). Conclusions and Relevance Medical cannabis laws are associated with significant reductions in opioid prescribing in the Medicare Part D population. This finding was particularly strong in states that permit dispensaries, and for reductions in hydrocodone and morphine prescriptions.