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Health PolicyChicago researchers on health policy use a variety of tools to analyze issues of socioeconomic determinants of disability, of health care delivery, and the outcomes of medical treatments. Some researchers are trained primarily in a specific discipline such as economics or medicine. Some combine disciplines David Meltzer has advanced degrees in both economics and medicine and Nicholas Christakis' degrees are in both sociology and medicine. The work on socioeconomic determinants of disability applies to several other social issues, including the well being of the elderly. Disability is the result of a complex process that begins with diseases, injuries, or congenital/developmental conditions, which lead to impairments in specific body systems. These lead in turn to functional limitations that result in disability within a specific social context. Disability results in a lowered quality of life and can lead to institutionalization, with its attendant monetary and personal costs. Avoiding individual disability and reducing its prevalence in the population remains a key social and policy goal. The prevalence of functional limitations and disability varies quite substantially across demographic groups. For example, Mexican American men and women experience rates of hip fracture close to twice those of Puerto Ricans (Lauderdale). Married adults living alone or with children show substantially better functioning across a range of dimensions than married adults living with others, single adults living alone, single adults living with children or single adults living with others. Black and Hispanic adults show lower functioning than white adults, even when we take into account socioeconomic status and family structure (Waite and Hughes). Some who enter nursing homes with dementia are discharged to their homes, some to a hospital, and some die. Given the very high levels of dementia among the oldest old, these pathways carry very different costs for the individuals involved, for their families and to social programs (Rudberg). The rate at which older people make the transition from healthy to limited to disabled states affects demand for long-term care as the population ages (Philipson). Use of specific types of care for the disabled and terminally-ill affects their quality of life and that of their families, and may affect how their longevity (Christakis; Christakis and Iwashyna). Complementing our program of research into the socioeconomic determinants of health and disability is a related research agenda seeking ways to improve the delivery of health care services and improve medical treatment outcomes. These studies promise to inform both local and national public policy to educate doctors about approaches to treatment, and promote organizational change in hospitals and long-term care facilities. Medical researchers and social scientists with appointments in the medical school are the prime movers of this agenda. David Meltzer addresses the issues at the most general and theoretical level in fundamental research into methods of medical cost-effectiveness analysis. This research raises important questions about the relative value of medical care at different ages, and suggests the need for greater attention to treatments that improve quality of life. He applies these methods to evaluations of screening and treatment of prostate cancer. David Weir studies the cost-effectiveness of pharmacological treatments for hypertension and the consequences of obesity for medical expenditures. Access to care is an important determinant of health care utilization. Marshall Chin is studying the role of community health centers and community-based health-promotion activities in improving the treatment of diabetes in underprivileged communities. Nicholas Christakis studies the familial determinants of access to hospice care for Alzheimer's patients. As important as family and community are to health, real progress in treating medical problems ultimately requires study of the large organizations in which medical treatment is received. David Meltzer is studying ways to improve general medicine care in the University of Chicago hospitals through a randomized trial of the use of physicians who specialize in inpatient care versus those who also maintain outpatient practices. Willard Manning is working on improvements to the care of patients following acute-care episodes. Mark Rudberg studies the determinants of declining function in nursing-home patients. He is devising measures of the quality of care in nursing homes that will help nursing homes to improve and state regulatory agencies to monitor their performance better. Substance abuse presents special challenges to medical treatment. Willard Manning studies how managed care fares in treating alcohol abuse. Peter Friedmann examines drug treatment programs. Awards to support the career development of younger scholars are a vital support to our research in this area, freeing scholars from clinical and teaching duties to dedicate more time to research. Geriatric Academic Program Awards (K-12) support three M.D.s: Marshall Chin, Nicholas Christakis, and David Meltzer. Marshall Chin has been investigating the effects of patient race and physician specialty on the outcomes of older persons with diabetes and congestive heart failure. David Meltzer has studied the impact of expectations of economic compensation on self-reported preferences for different health and disability states. David Weir has studied how married couples prepare financially for widowhood using the Health and Retirement Study, and has studied early-life predictors of adult mortality using Robert Fogel's Union Army study.
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