Health economics

Michael Darden, Nicholas W. Papageorge, 02 March 2019

When people lack options to manage pain many choose to ‘self-medicate’, turning to substances that are dangerous and ‘off label’ in an effort to seek relief. This column tests a theory of rational self-medication in the context of alcohol and depression. Selective serotonin reuptake inhibitors, which were approved in the US in the mid-1980s, appear to have had an indirect benefit by reducing the consumption of alcohol as an alternative form of self-medication for depression. The findings illustrate the importance of considering the behavioural ramifications of new medication and therapy.

James J Feigenbaum, Christopher Muller, Elizabeth Wrigley-Field, 18 February 2019

The mortality rate of non-Hispanic white Americans in midlife has been rising since the beginning of the 21st century, in contrast to the national decline in deaths from infectious disease witnessed during the previous century. This column reviews the fall in infectious mortality in US cities across regions and racial groups. It finds that southern cities had the highest rate of death from infectious disease in every year from 1900 to 1948, primarily because southern cities were populated by greater proportions of black residents, who suffered extreme risks from infectious disease in cities in all regions. 

Maryaline Catillon, David M. Cutler, Thomas E. Getzen, 09 February 2019

Growth in life expectancy during the last two centuries has been attributed to environmental change, productivity growth, improved nutrition, and better hygiene, rather than to advances in medical care. This column traces the development of medical care and the extension of longevity in the US from 1800 forward to provide a long-term look at health and health care in the US. It demonstrates that the contribution of medical care to life-expectancy gains changed over time. 

Frank Lichtenberg, 08 February 2019

Given the relationships between innovation and growth and between growth and longevity, it seems likely that new ideas have played a major role in increased longevity. This column examines the impact of medical innovation on cancer survival rates and mortality in the US. The findings suggest that a significant share of the increase in the five-year observed survival rate between 1994 and 2008 may have been due to an increase in the novelty of medical ideas several years earlier. Turning to the impact of new cancer drugs specifically, it finds that drugs launched in 36 countries during 2006-2010 reduced the number of disability-adjusted life years lost to cancer in 2015 in those countries by about 8.7%.

Carolina Lopez, Anja Sautmann, Simone Schaner, 29 January 2019

Healthcare systems around the world battle high rates of overtreatment. This column investigates the role of patient demand in this, using a randomised evaluation of malaria treatment at public health clinics in Mali. It finds no evidence of doctors attempting to increase treatment rates or intensity, instead heightened demand from patients sometimes pressured doctors into going against their own professional judgement and writing a prescription anyway. In such situations, interventions that make it easier for doctors to resist patient demands could help sustain subsidies and reduce overtreatment.

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