斯坦福卫生经济学教材（Health Economics）杰伊·巴塔查里亚《健康经济学》课程教学资源（PPT课件，英文版）Chapter 04 SOCIOECONOMIC DISPARITIES IN HEALTH

CHAPTER 4 SOCIOECONOMIC DISPARITIES IN HEALTH

CHAPTER 4 SOCIOECONOMIC DISPARITIES IN HEALTH

Intro Previously... Grossman model Individuals make choices about their health based on time constraints,budget constraints,and utility Optimal amount of health (H*)changes based on decisions about tradeoffs How does socioeconomic status(SES)affect health and choices about health? Does health determine SES?Or does SES determine health? Use empirical evidence to explore these questions Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Intro  Previously…  Grossman model  Individuals make choices about their health based on time constraints, budget constraints, and utility  Optimal amount of health (H*) changes based on decisions about tradeoffs  How does socioeconomic status (SES) affect health and choices about health?  Does health determine SES? Or does SES determine health?  Use empirical evidence to explore these questions

The pervasiveness of health disparities

The pervasiveness of health disparities

Health disparities are everywhere Health Disparity:(def)differences in health- incidence,prevalence,mortality,and burden of disease--between specific populations ex:death rates for all cancer types for both men and women are highest among African Americans1 Ubiquitous worldwide across races, educational attainments,employment grades, and incomes Broadly across all socioeconomic statuses(SES) Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Health disparities are everywhere  Health Disparity: (def) differences in health -- incidence, prevalence, mortality, and burden of disease -- between specific populations ex: death rates for all cancer types for both men and women are highest among African Americans1  Ubiquitous worldwide across races, educational attainments, employment grades, and incomes  Broadly across all socioeconomic statuses (SES)

Health disparities are everywhere By education: College graduates are 25%more likely to survive to age 68 than high school dropouts By race: Hispanics report better health status than black individuals White individuals report better health then both Hispanic and black individuals Health deteriorates with age across all races,but disparities persist Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Health disparities are everywhere  By education:  College graduates are 25% more likely to survive to age 68 than high school dropouts  By race:  Hispanics report better health status than black individuals  White individuals report better health then both Hispanic and black individuals  Health deteriorates with age across all races, but disparities persist

Health disparities across income Generally:high-income individuals self-report a higher health status than those of lower incomes For most conditions,the poor exhibit more incidences of disease Some exceptions like Bronchitis--no difference Hay fever--the rich appear to be diagnosed with hay fever more often May be explainable if richer children visit the doctor more often and hence,are more likely to be diagnosed Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Health disparities across income  Generally: high-income individuals self-report a higher health status than those of lower incomes  For most conditions, the poor exhibit more incidences of disease  Some exceptions like  Bronchitis -- no difference  Hay fever -- the rich appear to be diagnosed with hay fever more often  May be explainable if richer children visit the doctor more often and hence, are more likely to be diagnosed

Disparities even with universal insurance Even in countries with universal health insurance, health disparities persist Canada: Self-reported health status for children at high SES better than children of low SES(Currie and Stabile 2003) England: We discuss the Whitehall studies later Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Disparities even with universal insurance  Even in countries with universal health insurance, health disparities persist  Canada:  Self-reported health status for children at high SES better than children of low SES (Currie and Stabile 2003)  England:  We discuss the Whitehall studies later

Theories to explain health disparities

Theories to explain health disparities

Why do health disparities exist? Reasons/theories Early life events Income levels Stress of being poor Work capacity ▣Impatience Adherence to medical advice Policy importance of understanding causes of disparities before addressing them Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Why do health disparities exist?  Reasons/theories Early life events Income levels Stress of being poor Work capacity Impatience Adherence to medical advice  Policy importance of understanding causes of disparities before addressing them

What causes what? Does bad health cause low SES? Does low SES cause bad health? Are there other factors? Health SES Other variables Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics What causes what?  Does bad health cause low SES?  Does low SES cause bad health?  Are there other factors?