ARRA IMPACT REPORT:
Economics of Aging


Public Health Burden
Economic status, well-being, and health care are interrelated in complex ways for older adults. As record numbers of Americans reach retirement age, programs such as Social Security and Medicare will face unprecedented challenges. In addition, demographic and retirement income trends are expanding economic risks in old age. Longer life expectancy can increase the likelihood of outliving retirement savings, and the shift in pensions from defined benefit to defined contribution plans suggests that more Americans will reach retirement with Social Security as their only annuity. Many Americans will require long-term care, but few purchase private insurance to support formal care expenses.

Understanding How Economic Concerns Impact Older Adults
ARRA funds have been used in several large population studies to better understand the economic needs of older adults. The following are examples:

  • Investigators with the Health and Retirement Study (HRS), an NIH-supported longitudinal study known as the nation’s leading resource for data on the combined health and economic conditions of older Americans, added new measures to the study. For example, over 12,500 participants have been genotyped; the addition of genetic data provides a major new dimension for the study and is expected to result in much deeper insights into how we age.1
  • HRS investigators have also doubled the size of the minority sample in the study. This will enhance the statistical power of HRS data on the sources of disparities in health and economic status.2,3
  • NIA used ARRA funds to establish a new Center on the Demography and Economics of Aging at Johns Hopkins University. Investigators at that Center are focusing on disability and intergenerational support.4

Evaluating Interventions
ARRA funds have been used to evaluate the success of various interventions to address economic concerns among the elderly. The following are examples:

  • Preliminary results were released from the “Oregon Lottery” study, in which randomly-selected low-income Oregon residents were able to enroll in the state’s Medicaid program. Compared to a control group, the new Medicaid enrollees reported improved health and well-being, as well as reduced financial strain. Use of important types of health care services such as preventive care also increased.5
  • Researchers6 have begun to determine the impact of Medicare Part D implementation on racial disparities in medication use and control of chronic diseases such as hypertension and ischemic heart disease. They have found that regional variation in Medicare Part D spending results largely from differences in the cost of drugs selected rather than prescription volume, suggesting that a reduction in branded-drug use in some regions through modification of Part D plan benefits might lower costs without reducing quality of care.7

Using Economic Incentives to Increase Uptake of Comparative Effectiveness Research
Comparative effectiveness research (CER) holds significant promise to improve health care quality and potentially lower costs. However, it appears that knowledge of which procedures and treatments are comparatively effective may not be sufficient to change critical provider practices and crucial patient behaviors.

ARRA-supported investigators have established the first large-scale clinical trials to determine whether the use of incentives will increase physicians’ adoption of interventions identified as effective through CER. One trial focuses on using financial incentives with patients and physicians to reduce LDL cholesterol among patients at high risk of cardiovascular disease.8 Another is assessing the efficacy of various behavioral nudges in preventing inappropriate use of prescription antibiotics for most upper respiratory infections.9

Enhancing Research Resources
ARRA-supported researchers have developed the Way to Health web-based portal, an information technology infrastructure that will provide a state-of-the-art platform on which to build, test, and deploy large-scale behavioral intervention studies and advance the science at the intersection of behavioral economics and health. The Way to Health portal is currently being used in pilot studies of behavioral economic interventions for smoking cessation and Continuous Positive Airway Pressure (CPAP) adherence in sleep apnea, and other studies are planned.10

Contributing NIH Institutes & Centers

  • National Institute on Aging (NIA)

  1. 3U01AG009740-20S1 - WEIR, DAVID R. - UNIVERSITY OF MICHIGAN AT ANN ARBOR - ANN ARBOR - MI
  2. 3U01AG009740-20S2 - WEIR, DAVID R. - UNIVERSITY OF MICHIGAN AT ANN ARBOR - ANN ARBOR - MI
  3. More information on the Health and Retirement Study can be found at http://hrsonline.isr.umich.edu/.
  4. 1P30AG034460-01 - AGREE, EMILY M - JOHNS HOPKINS UNIVERSITY - BALTIMORE - MD
  5. 1RC2AG036631-01, http://www.ncbi.nlm.nih.gov/pubmed/21774703 - BAICKER, KATHERINE - NATIONAL BUREAU OF ECONOMIC RESEARCH - CAMBRIDGE - MA
  6. 1R01AG034056-01 - HANLON, JOSEPH T - UNIVERSITY OF PITTSBURGH AT PITTSBURGH - PITTSBURGH - PA
  7. http://www.ncbi.nlm.nih.gov/pubmed/22316446
  8. 1RC4AG039114-01 - VOLPP, KEVIN G - UNIVERSITY OF PENNSYLVANIA - PHILADELPHIA - PA
  9. 1RC4AG039115-01 - DOCTOR, JASON N - UNIVERSITY OF SOUTHERN CALIFORNIA - LOS ANGELES - CA
  10. See also http://www.waytohealth.org.
    1RC2AG036592-01 - VOLPP, KEVIN G - UNIVERSITY OF PENNSYLVANIA - PHILADELPHIA - PA