Healthy lifestyle, disease prevention and health care utilization

Rashmita Basu

doi:10.7273/000005637

This dissertation consists of three independent but related essays in the field of health economics. The two main focus areas of my dissertation include prevention through healthy lifestyle and dementia caregiving in the United States-implications for long-term care decisions. The first essay presents a theoretical characterization of individual investments in self-protection that mitigates the risk of future ill health and the interaction between market insurance and self-protection in reducing uncertain financial losses. It also examines the role of self-insurance (through saving) in offsetting future health costs. The results suggest that self-protection can be a substitute or complement for market insurance, and self- insurance and market insurance can coexist in lowering the severity of a potential future loss. The findings of this paper have implications for policymakers who want to encourage self-protective behavior to reduce the burdens of chronic and preventable illnesses. The second essay examines a set of lifestyle characteristics that are potential protective or risk factors for dementia and other cognitive impairments among older individuals in the U.S. The use of instrumental variables technique provides evidence in favor of a causal relationship between education and the risk of dementia. From a policy perspective the causality question is important for evaluation of the effectiveness of public expenditures on education. Some important lifestyle related risk factors are advancing age, an incidence of stroke, and a specific genetic make up. The final essay analyzes a sequence of individual characteristics of patients and family caregivers that jointly predict the optimal mix of informal and formal health care services utilized by dementia patients in this country. In addition, this study investigates the effect of a caregiver's satisfactions and gratifications on the provision of informal and formal care services. Results indicate that a measure of "altruism" is associated with an increased level of informal care and delays institutionalization. A patient's need for supervision help is an important predictor for both informal and all types of formal care services. These findings have profound social and health implications for extending publicly funded long-term care (LTC) resources and developing appropriate intervention policies to promote the well-being of patients and caregivers.

Healthy lifestyle, disease prevention and health care utilization

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