Econ Papers Daily / 期刊论文
医学创新与健康差距
Medical innovation and health disparities
摘要
A long-standing question in health economics asks what drives heterogeneity in health investments across sociodemographic groups, which contribute to health disparities. We examine a novel source: variation by sociodemographic groups in the impact of medical treatment side effects. We estimate a lifecycle model of medication and labor supply decisions using data on men infected with human immunodeficiency virus (HIV) and with different levels of completed education. Agents in the model make dynamic medication and work choices as a function of expected income, health, and mortality. We also include utility costs of side effects, which can interact with the utility cost of work, and allow these parameters to vary by education. We use the estimated model to evaluate the disparate impacts of an effective HIV treatment innovation that had harsh side effects: HAART (which stands for highly active antiretroviral treatment). Measured in lifetime utility gains, HAART disproportionately benefited patients with more education in part due to differences in income and mortality, but also due to smaller impacts of side effects on labor supply. We also simulate the effects of a HAART treatment mandate, which mimics assignment to treatment in a clinical trial. The mandate improves health, which might be viewed as a success in a randomized trial. However, this masks the downsides of treatment, including lower labor supply due to side effects, especially for lower-education men. Broadly, viewing heterogeneity in health investments as solely a result of barriers to access is overly simplistic. Individually optimal investments in health may in part reflect the costs of managing side effects and work. If low health investments create negative externalities (e.g., due to increased use of publicly-funded healthcare), the benefits of policies that moderate resulting health-work tradeoffs could outweigh the costs.
中文摘要
健康经济学中一个长期存在的问题是，什么因素导致了不同社会人口群体在健康投资上的异质性，这种异质性进而加剧了健康差距。我们考察了一个新的来源：社会人口群体在医疗治疗副作用影响上的差异。我们利用感染人类免疫缺陷病毒（HIV）且教育程度不同的男性数据，估计了一个关于服药和劳动供给决策的生命周期模型。模型中的个体根据预期收入、健康状况和死亡率做出动态的服药与工作选择。我们还将副作用的效用成本纳入模型，这些成本可能与工作的效用成本相互作用，并允许这些参数因教育程度而异。我们利用估计的模型评估了一种具有严重副作用的有效HIV治疗创新——HAART（即高效抗逆转录病毒治疗）——对不同群体的差异化影响。以终身效用增益衡量，HAART不成比例地惠及教育程度较高的患者，部分原因在于收入和死亡率的差异，但也因为副作用对劳动供给的影响较小。我们还模拟了HAART治疗强制实施的效果，这类似于临床试验中的治疗分配。强制实施改善了健康状况，这在随机试验中可能被视为成功。然而，这掩盖了治疗的负面影响，包括因副作用导致的劳动供给下降，尤其是对教育程度较低的男性而言。总体来看，将健康投资的异质性仅仅视为获取障碍的结果是过于简单化的。个体最优的健康投资可能部分反映了管理副作用和工作的成本。如果低健康投资产生负外部性（例如，由于公共资助医疗服务的增加使用），那么调节由此产生的健康与工作权衡的政策的收益可能超过其成本。