国会预算办公室-气候变化引起的极端温度对医疗保险人群的影响：初步结果（英）.pdf

PresentationattheAssociationofEnvironmentalandResourceEconomistsSummerConferenceMay31,2024JaredJageler,DavidAdler,NoeliaDuchovny,andEvanHerrnstadtMicroeconomicStudiesDivisionandHealthAnalysisDivisionEffectsofExtremeTemperaturesFromClimateChangeontheMedicarePopulation:PreliminaryResultsForinformationabouttheconference,seewww.aere.org/summer.1Theinformationinthispresentationispreliminaryandisbeingcirculatedtostimulatediscussionandcriticalcomment.Climatechangeisexpectedtoincreaseaveragetemperaturesandaffectthefrequencyofextremelyhotandcolddays.Theneteffectsofthosechangingtemperaturesonhealthandfederalhealthcarespendingareuncertain:▪Extremeheatandcoldareassociatedwitharangeofnegativehealtheffects.▪Spendingandutilizationcouldincreaseordecreasedependingonhowhealtheffectsandbehaviorrespondtoextremetemperatures.▪Mortalitycouldincrease(becauseofmorehotdays)ordecrease(becauseoffewercolddays).Thoseeffectsmaybepronouncedamongelderlypopulations,withimplicationsforthefederalbudgetrelatedtoMedicareenrolleesandspending.Introduction2Adaptationreferstohowareaswithdifferentclimatesrespondtoincreasingtemperaturesdifferently,suchasbyinstallingmoreairconditioning.TheCongressionalBudgetOfficeusesacompletenationwidedatasetofMedicarebeneficiariestoexaminehealthcareutilizationandspendingaswellasmortality.Inparticular,CBOinvestigatesthesequestions:▪Whatistheeffectofextremetemperaturesonemergencydepartment(ED)visits,EDspending,andmortalityamongMedicarebeneficiaries?▪Howwillthoseoutcomesbeaffectedbyprojectedtemperaturesresultingfromclimatechange,afterincorporatingtheeffectsofadaptation?Thisresearchispreliminary,andtheresultsaresubjecttochange.ResearchQuestions3▪Nationwidestudiesontheeffectsofclimatechangeonmortality–Heutel,Miller,andMolitor(2021)–Carletonandothers(2022)▪Otherrecentresearchonhealthcareutilization(EDvisits)andmortalityinCaliforniahospitals:–White(2017)–Gouldandothers(2024)▪AstudyestimatingtheeffectsofexposuretoparticulatepollutiononsimilaroutcomesintheMedicarepopulation–Deryuginaandothers(2019)RelatedResearch4Overall,CBOfindsadailyweightedaverageof11deaths,156EDvisits,and$388,000inspendingper100,000Medicareenrollees.ED=emergencydepartment.Overview:EconometricEstimatesVeryhotdayscausemoreEDvisitsandhigherEDspending.Bycontrast,verycolddayscauseareductioninEDvisitsandasmallerreductioninEDspending.Mortalityishigheronbothveryhotandverycolddays.Thecurrentestimatesshowtheeffectofweatheronlyonoutcomesforthesamedayandthefollowingtwodays,whichcouldexcludesomedelayedandcompensatoryeffects.CBOplanstoexplorelongerwindowsinfutureversionsofthisanalysis,whichcouldchangetheresults.5Dailyaveragetemperatureisthesimplemeanofdailyminimumandmaximumtemperatures.MedicareOutcomes▪DailycountsofEDvisitsandspendingbyzipcode(2000to2019)forfee-for-service(FFS)enrollees–Alsodisaggregatedtoinpatient(IP)andoutpatient(OP)visitsandspending;IPinvolvesanovernighthospitalstay,butOPdoesnot▪Dailydeathsbyzipcodeper100,000enrollees(2000to2019)–IncludesFFSandMedicareAdvantageWeather▪Dailyaveragetempera