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Cutler, David M.

Works: 96 works in 659 publications in 1 language and 9,449 library holdings
Genres: Conference proceedings  History 
Roles: Editor
Classifications: RA395.A3, 362.10973
Publication Timeline
Publications about David M Cutler
Publications by David M Cutler
Most widely held works by David M Cutler
Your money or your life strong medicine for America's health care system by David M Cutler( file )
12 editions published between 2004 and 2007 in English and held by 2,397 libraries worldwide
"The problems of medical care confront us daily: a bureaucracy that makes a trip to the doctor worse than a trip to the dentist, doctors who can't practice medicine the way they choose, more than 40 million people without health insurance. "Medical care is in crisis," we are repeatedly told, and so it is. Barely one of five Americans thinks the medical system works well." "Enter David M. Cutler, a Harvard economist who served on President Clinton's health care task force and later advised presidential candidate Bill Bradley. One of the nation's leading experts on the subject, Cutler argues in Your Money or Your Life that health care has in fact improved exponentially over the last fifty years, and that the successes of our system suggest ways in which we might improve care, make the system easier to deal with, and extend coverage to all Americans. Cutler applies an economic analysis to show that our spending on medicine is well worth it - and that we could do even better by spending more. Further, millions of people with easily manageable diseases, from hypertension to depression to diabetes, receive either too much or too little care because of inefficiencies in the way we reimburse care, resulting in poor health and in some cases premature death."--Résumé de l'éditeur
Frontiers in health policy research by Frontiers in Health Policy Research Conference( file )
3 editions published between 2004 and 2005 in English and held by 840 libraries worldwide
Frontiers in health policy research ( file )
3 editions published in 2003 in English and held by 646 libraries worldwide
Health at older ages : the causes and consequences of declining disability among the elderly by David M Cutler( Book )
9 editions published between 2008 and 2009 in English and held by 395 libraries worldwide
Americans are living longer--and staying healthier longer--than ever before. Despite the rapid disappearance of pensions and health care benefits for retirees, older people are healthier and better off than they were twenty years ago. In Health at Older Ages, a distinguished team of economists analyzes the foundations of disability decline, quantifies this phenomenon in economic terms, and proposes what might be done to accelerate future improvements in the health of our most elderly populations. This breakthrough volume argues that educational attainment, high socioeconomic status, an older ret
Demographics and medical care spending : standard and non-standard effects by David M Cutler( Book )
13 editions published between 1998 and 1999 in English and held by 117 libraries worldwide
In this paper, we examine the effects of likely demographic changes on medical spending for the elderly. Standard forecasts highlight the potential for greater life expectancy to increase costs: medical costs generally increase with age, and greater life expectancy means that more of the elderly will be in the older age groups. Two factors work in the other direction, however. First, increases in life expectancy mean that a smaller share of the elderly will be in the last year of life, when medical costs generally are very high. Furthermore, more of the elderly will be dying at older ages, and end-of-life costs typically decline with age at death. Second, disability rates among the surviving population have been declining in recent years by 0.5 to 1.5 percent annually. Reductions in disability, if sustained, will also reduce medical spending. Thus, changes in disability and mortality should, on net, reduce average medical spending on the elderly. However, these effects are not as large as the projected increase in medical spending stemming from increases in overall medical costs. Technological change in medicine at anywhere near its historic rate would still result in a substantial public sector burden for medical costs
Restraining the leviathan : property tax limitation in Massachusetts by David M Cutler( Book )
13 editions published between 1996 and 1999 in English and held by 107 libraries worldwide
Proposition 2.5, a ballot initiative approved by Massachusetts voters in 1980 sharply reduced local property taxes and restricted their future growth. We examine the effects of Proposition 2.5 on municipal finances and assess voter satisfaction with these effects. We find that Proposition 2.5 had a smaller impact on local revenues and spending than expected; amendments to the law and a strong economy combined to boost both property tax revenue and state aid above forecasted amounts. Proposition 2.5 did reduce local revenues substantially during the recession of the early 1990s. There were two reasons for voter discontent with the pre-Proposition 2.5 financing system: agency losses from inability to monitor government were perceived to be high, and individuals viewed government as inefficient because their own tax burden was high. Through override votes, voters approved substantial amounts of taxes above the limits imposed by the Proposition
Adverse selection in health insurance by David M Cutler( Book )
11 editions published in 1997 in English and held by 106 libraries worldwide
Individual choice over health insurance policies may result in risk-based sorting across plans. Such adverse selection induces three types of losses: efficiency losses from individuals being allocated to the wrong plans; risk sharing losses since premium variability is increased; and losses from insurers distorting their policies to improve their mix of insureds. We discuss the potential for these losses, and present empirical evidence on adverse selection in two groups of employees: Harvard University, and the Group Insurance Commission of Massachusetts (serving state and local employees). In both groups, adverse selection is a significant concern. At Harvard, the University's decision to contribute an equal amount to all insurance plans led to the disappearance of the most generous policy within 3 years. At the GIC, adverse selection has been contained by subsidizing premiums on a proportional basis and managing the most generous policy very tightly. A combination of prospective or retrospective risk adjustment, coupled with reinsurance for high cost cases, seems promising as a way to provide appropriate incentives for enrollees and to reduce losses from adverse selection
Labor market responses to rising health insurance costs : evidence on hours worked by David M Cutler( Book )
9 editions published in 1996 in English and held by 105 libraries worldwide
Increases in the cost of providing health insurance must have some effect on labor markets, either in lower wages, changes in the composition of employment, or both. Despite a presumption that most of this effect will be in the form of lower wages, we document in this paper a significant effect on work hours as well. Using data from the CPS and the SIPP, we show that rising health insurance costs over the 1980s increased the hours worked of those with health insurance by up to 3 percent. We argue that this occurs because health insurance is a fixed cost, and as it becomes more expensive to provide, firms face an incentive to substitute hours per worker for the number of workers employed
Are medical prices declining? by David M Cutler( Book )
9 editions published in 1996 in English and held by 104 libraries worldwide
We address long-standing problems in measuring health care prices by estimating two medical care price indices. The first, a Service Price Index, prices specific medical services, as does the current CPI. The second, a Cost of Living Index, measures the net valuation of treating a health problem. We apply these indices to heart attack treatment between 1983 and 1994. Because of technological change and increasing price discounts, the current CPI overstates a chain-weighted price index by three percentage points annually. For plausible values of an additional life-year, the real Cost of Living Index fell about 1 percent annually
Paying for health insurance : the tradeoff between competition and adverse selection by David M Cutler( Book )
11 editions published in 1996 in English and held by 104 libraries worldwide
This paper uses data on health insurance choices by employees of Harvard University to examine the effect of alternative pricing rules on market equilibrium. In the mid-1990s, Harvard moved from a system of subsidizing more expensive insurance to a system of contributing an equal amount to each plan. We estimate a substantial demand response to the policy change, with a short-run elasticity of about -2. The reform also induced substantial" adverse selection. Because of this selection, the long-run demand response is three times the short-run response. Price variation induced by adverse selection is inefficient; we estimate the magnitude of the welfare loss from adverse selection at 2 percent of baseline health spending. Finally, as insurance choice was made more competitive, premiums to Harvard fell relative to premiums in the Boston area by nearly 10 percent. This savings was large enough to compensate for the inefficiency induced by adverse selection, so that reform overall was welfare enhancing
Prices and productivity in managed care insurance by David M Cutler( Book )
11 editions published in 1998 in English and held by 103 libraries worldwide
Integrating the health services and insurance industries (HMOs) could lower expenditure by reducing either the quantity of services or unit price. We compare the treatment of heart attacks and newly diagnosed chest pain in HMOs and traditional plans in two data sets. The nature of these health problems should minimize selection, and OLS and instrumental-variable estimates yield consistent results. HMOs have 30 to 40 percent lower expenditures than traditional indemnity plans. Actual treatments and health outcomes differ little; virtually all the difference in spending comes from lower unit prices. Managed care may yield substantial productivity improvements relative to traditional insurance
Public policy for health care by David M Cutler( Book )
10 editions published in 1996 in English and held by 103 libraries worldwide
This paper reviews the public sector role in the provision of health care. A first role of the government is to use tax policy to correct externalities associated with individual behaviors. Estimates suggest that the external effects of many sins' such as alcohol consumption are greater than current taxes on these goods. A second role of the government is to correct distortions in markets for medical care and health insurance. Markets for health insurance have traditionally not offered a choice between cost and the generosity of benefits. As a result, there have been incentives for excessive technological development, particularly technologies that increase spending. Once technologies have diffused widely, they are overutilized. Policies to increase choice in insurance markets could increase welfare, provided they limit segmentation on the basis of risk
The determinants of technological change in heart attack treatment by David M Cutler( Book )
9 editions published between 1995 and 1996 in English and held by 101 libraries worldwide
This paper examines the sources of expenditure growth in heart attack treatment. We first show that essentially all of cost growth is a result of the diffusion of particular intensive technologies; the prices paid for a given level of technology have been constant or falling over time. We then examine the reasons for this technology diffusion. We distinguish six factors that may influence technology diffusion: organizational factors within hospitals; the insurance environment in which technology is reimbursed; public policy regulating new technology; malpractice concerns; competitive or cooperative interactions among providers; and demographic composition. We conclude that insurance variables, technology regulation, and provider interactions have the largest quantitative effect on technological diffusion. These factors affect both technology acquisition and the frequency of technology use
Managed care and the growth of medical expenditures by David M Cutler( Book )
10 editions published in 1997 in English and held by 101 libraries worldwide
We use data across states to examine the relation between HMO enrollment and medical spending. We find that increased managed care enrollment significantly reduces hospital cost growth. While some of this effect is offset by increased spending on physicians, we generally find a significant reduction in total spending as well. In analyzing the sources of hospital cost reductions, we find preliminary evidence that managed care has reduced the diffusion of medical technologies. States with high managed care enrollment were technology leaders in the early 1980s; by the early 1990s those states were only average in their acquisition of new technologies. This finding suggests managed care may have a significant effect on the long-run growth of medical spending
Are ghettos good or bad? by David M Cutler( Book )
12 editions published between 1995 and 1997 in English and held by 100 libraries worldwide
Theory suggests that spatial separation of racial and ethnic groups can have both positive and negative effects on the economic performance of minorities. Racial segregation may be damaging because it curtails informational connections with the larger community or because concentrations of poverty deter human capital accumulation and encourage crime. Alternatively racial segregation might ensure that minorities have middle-class role models and thus promote good outcomes. We examine the effects of segregation on African-American outcomes in schooling, employment and single parenthood and find that African-Americans in more segregated areas do significantly worse, particularly if they live in central cities. We control for the endogeneity of location choice using instruments based on political factors, topographical features of cities, and residence before adulthood. Some, but never more than 40% of this effect, stems from lack of role models and large commuting times
The rise and decline of the American ghetto by David M Cutler( Book )
9 editions published in 1997 in English and held by 99 libraries worldwide
This paper examines segregation in American cities from 1890 to 1990. We divide the century into three time periods. From 1890 to 1940, ghettos were born as blacks migrated to urban areas and cities developed vast expanses filled with nearly exclusively black housing. From 1940 to 1970, black migration continued and ghettos expanded. Since 1970, there has been a decline in segregation as blacks have moved to suburban areas and central cities have become less segregated. Across all of these time periods there is a strong positive relation between urban population or density and segregation. We then examine why segregation has varied so much over time. We find evidence that the mechanism sustaining segregation has changed. In the mid-20th century taken by whites to exclude blacks from their neighborhoods. By 1990, these legal barriers enforcing segregation had been replaced by decentralized racism, where whites pay more than blacks to live in predominantly white areas
The medical costs of the young and old : a forty year perspective by David M Cutler( Book )
11 editions published in 1997 in English and held by 97 libraries worldwide
In this paper, we examine the growth in medical care spending by age over the past 40 years. We show that between 1953 and 1987, medical spending increased disproportionately for infants, those under 1 year, and the elderly, those 65 and older. Annual spending growth for infants was 9.8 percent and growth for the elderly was 8.0 percent compared to 4.7 percent for people aged 1-64. Within the infant and the elderly population, excess spending growth was largely driven by more rapid growth of spending at the top of the medical spending distribution. Aggregate changes in outcomes for infants and the elderly are consistent with these changes in spending growth, but we do not present any causal evidence on this point
The anatomy of health insurance by David M Cutler( Book )
10 editions published in 1999 in English and held by 97 libraries worldwide
This article describes the anatomy of health insurance. It begins by considering the optimal design of health insurance policies. Such policies must make tradeoffs appropriately between risk sharing on the one hand and agency problems such as moral hazard (the incentive of people to seek more care when they are insured) and supplier-induced demand (the incentive of physicians to provide more care when they are well reimbursed) on the other. Optimal coinsurance arrangements make patients pay for care up to the point where the marginal gains from less risk sharing are just offset by the marginal benefits from less wasteful care being provided. Empirical evidence shows that both moral hazard and demand-inducement are quantitatively important. Coinsurance based on expenditure is a crude control mechanism. Moreover, it places no direct incentives on physicians, who are responsible for most expenditure decisions. To place such incentives on physicians is the goal of supply-side cost containment measures, such as utilization review and capitation. This goal motivates the surge in managed care in the United States, which unites the functions of insurance and provision, and allows for active management of the care that is delivered. The analysis then turns to the operation of health insurance markets. Economists generally favor choice in health insurance for the same reasons they favor choice in other markets: choice allows people to opt for the plan that is best for them and encourages plans to provide services efficiently. But choice in health insurance is a mixed blessing because of adverse selection -- the tendency for the sick to choose more generous insurance than the healthy. When sick and healthy enroll in different plans, plans disproportionately composed of poor risks have to charge more than they would if they insured an average mix of people. The resulting high premiums create two adverse effects: they discourage those who are healthier but would prefer generous care from enrolling in those
Employee costs and the decline in health insurance coverage by David M Cutler( Book )
8 editions published in 2002 in English and held by 94 libraries worldwide
This paper examines why health insurance coverage fell despite the lengthy economic boom of the 1990s. I show that insurance coverage declined primarily because fewer workers took up coverage when offered it, not because fewer workers were offered insurance or were eligible for it. The reduction in take-up is associated with the increase in employee costs for health insurance. Estimates suggest that increased costs to employees can explain the entire decline in take-up rates in the 1990s
Reinsurance for catastrophies and cataclysms by David M Cutler( Book )
11 editions published between 1997 and 1999 in English and held by 94 libraries worldwide
This paper examines the optimal design of insurance and reinsurance policies. We first consider reinsurance for catastrophes: risks which are large for any one insurer but not for the reinsurance market as a whole. Reinsurance for catastrophes is complicated by adverse selection. Optimal reinsurnace in the presence of adverse selection depends critically on the source of information asymmetry. When information on the probability of a loss is private but the magnitude of the loss is public optimal reinsurance employs a deductible-style deductible-style excess-of-loss policy, and when is is private but the proba- bility of a loss is common, optimal reinsurance covers small and large risks, but makes the primary insurer responsible for moderate risks. There is a dramatic divergence between these designs, which suggests that traditional approaches to design may be misguided. We then consider reinsurance for cata- clysms: risks that are so large that a loss can threaten the solvency of re- insurance such as a major earthquake, while others derive from common risks-changes in conditions that affect many individuals-such as the liability revolution or or escalating medical care costs. We argue that cataclysms must be reinsured in either broad securities markets or by the government. Beyond their one- period loss potential, cataclysms pose another risk: risk levels change over time. A simulation model traces the implications of evolving risk levels for long-term patterns of losses and premiums, where the latter reflect learning learning about loss distributions. Premium risk emerges as an important part of risk, which reinsurance and primary insurance markets do not adequately diversify."
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Alternative Names
Cutler, D. 1965-
Cutler, D. M. 1965-
Cutler, David, 1965-
Cutler, David Matthew 1965-
English (194)
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