External Costs of Obesity

肥胖的外部成本

基本信息

批准号：
7496934
负责人：
Jay Bhattacharya
金额：
$ 22.59万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-15 至 2010-08-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Adult obesity is a thorny public health problem. A large literature documents rising obesity prevalence in the U.S., and measures the associated health and accounting costs. Over a decade ago, Wolf and Colditz measured the health care costs and lost workplace productivity due to obesity to be over $68 billion annually. The morbidity and accounting costs associated with obesity have led economists and public health practitioners alike to advocate vigorous public intervention. However, measures of medical costs due to obesity are not, in and of themselves, germane to the debate over whether public actions to curb obesity are justified. Rather, it is the costs of body weight decisions not borne by an adult making those decisions (hereafter, external costs) that are most relevant. An important mechanism by which obesity is (potentially) subsidized is through health insurance. There is a small empirical literature aimed at measuring the cost of public health insurance attributable to obesity. This literature focuses solely on health expenditure differences between obese and non-obese adults but ignores relevant payment differences. In the case of Medicare, for example, this literature does not consider differential contributions via taxes, differential obesity-related mortality, and the timing of health care expenditures. In the case of employer provided private insurance, the literature ignores the possibility (implied by the theory of compensating wage differentials) that, relative to thinner workers, covered obese workers are reduced because of their higher expected medical expenditures. Even a proper measurement of the subsidy is not enough to calculate the welfare loss from the obesity externality caused by health insurance. If the subsidy does not change the behavior of the people in a health insurance pool, then the subsidy is just a costless transfer from the thin to the obese that does not change social welfare. The key question is: to what extent do transfers to obese adults change incentives regarding their diet and exercise decisions? The welfare loss from the externality is proportional to both the size of the subsidy and the elasticity of body weight decisions with respect to the subsidy. We propose three tasks: (1) to measure the net subsidy from non-obese to obese individuals induced by Medicare from a lifetime point of view; (2) to measure the net subsidy induced by employer-provided health insurance; and (3) to measure the extent to which body weight decisions are distorted by health insurance induced subsidies.

描述（由申请人提供）：成人肥胖是一个棘手的公共卫生问题。大量文献记录了美国肥胖症患病率的上升，并衡量了相关的健康和会计费用。十年前，沃尔夫（Wolf）和柯蒂兹（Colditz）测量了医疗保健成本，由于肥胖症每年超过680亿美元，因此失去了工作场所的生产力。与肥胖相关的发病率和会计成本使经济学家和公共卫生从业人员都提倡强烈的公共干预。但是，肥胖造成的医疗费用措施本身并不是关于公共行为是否合理的辩论。相反，最相关的是成人做出这些决定（以下简称外部成本）而不是体重决定的成本。肥胖（潜在）补贴的一种重要机制是通过健康保险。有一个小的经验文献旨在衡量归因于肥胖症的公共卫生保险成本。该文献仅关注肥胖和非肥胖成年人之间的健康支出差异，但忽略了相关的付款差异。例如，就Medicare而言，该文献不会考虑通过税收，与肥胖相关的差异死亡率和医疗保健支出的时间来考虑差异贡献。对于雇主提供的私人保险，文献忽略了可能性（补偿工资差异的理论所暗示的），即相对于较瘦的工人，由于他们的预期医疗支出较高，因此减少了覆盖的肥胖工人。即使是对补贴的适当衡量也不足以计算由健康保险造成的肥胖外部性的福利损失。如果补贴不会改变健康保险库中人民的行为，那么补贴只是从薄薄到肥胖的无价转移，而不会改变社会福利。关键问题是：向肥胖成年人转移在多大程度上改变了他们的饮食和锻炼决定的激励措施？外部性的福利损失与补贴的大小和相对于补贴的弹性成正比。我们提出三个任务：（1）从医疗保险终生的角度来衡量从非肥胖到肥胖个体的净补贴；（2）衡量由雇主提供的健康保险引起的净补贴；（3）衡量健康保险诱发的补贴扭曲体重决策的程度。