Inequality in health care expenditures and health outcomes among the United States elderly population

The main purpose of this dissertation is to investigate the existence and nature of inequality in health care expenditures and health outcomes among the Medicare population. First, I consider the role that Medicare plays in changing the distribution of income and health. Second, I examine the effects of race, income and income inequality on the health of Medicare patients with acute myocardial infarction (AMI).; The first chapter estimates the flow of Medicare benefits to high-income and low-income neighborhoods in 1990 and 1995. The results show that Medicare spending per capita for the lowest income groups grew much more rapidly than Medicare spending in either high-income or middle-income neighborhoods. Home health care spending played an important role in the increased spending among the lowest income neighborhoods. This differential shift in spending exceeds in magnitude the entire per capita transfer from the Earned Income Tax Credit (EITC) and is half of the average transfers to the elderly poor from Supplemental Security Income (SSI).; The second chapter documents the changes in mortality and treatment rates among more than 3 million AMI patients during the period 1985–1998. Results in this chapter show that: (1) the dramatic declines in AMI mortality observed during the late 1980s and early 1990s have stagnated during the later 1990s; (2) although there exist differences in AMI mortality and treatment between income groups, larger differences exist between blacks and nonblacks; and (3) racial differences in AMI mortality and treatment have only widened over time.; During the past decade, a new body of research has proposed that income inequality, and not simply income per se, is detrimental to individual health. According to the income inequality hypothesis (IIH), those who live in a more unequal society suffer worse health than those who do not. The third chapter estimates the effects of state-level income inequality on AMI mortality. The first result is that the only association between inequality and health exists for measures of inequality related to the lower end of the income distribution. The second result is that there exists an association between health and the percent of black households in the state, even after controlling for individual income, state-level inequality and regional effects.