Health and care

The evidence on health and care in this part comes in several kinds, and each answers a different question. Modeled prevalence for census tracts, from CDC PLACES, describes neighborhoods and holds no record of any person. A telephone survey that asks each adult about behavior and household income describes people, but places them only by state. Counts of physicians, dentists and mental health providers describe the supply of care in counties. Disabled workers and retired workers are two kinds of Social Security beneficiary, counted by ZIP code, and Medicare payments describe the beneficiaries enrolled in the fee-for-service program in a county. Medicare and Social Security apply one set of rules across the country, so differences by place in what they pay, and to whom, show how a single rule reaches different populations. A pattern in one kind of evidence does not confirm a pattern in another, and the methods page explains how to read the modeled estimates.

Chapter 7.1, Health behaviors and the supply of care sets the PLACES measures against tract deprivation. In the most deprived tenth of tracts the share of adults who saw a dentist in the past year is lower than in the least deprived tenth, while the share who had a routine checkup is higher, so the checkup does not follow the gradient that the dental visit does. The chapter then finds the supply of providers thinner in more deprived counties, an association that could run in either direction or through a third factor such as rurality.

Chapter 7.2, Health behaviors, person by person asks whether the neighborhood patterns hold when each adult is measured. Binge drinking is more common in higher household income bands, while smoking, obesity and physical inactivity are less common there. The rise in binge drinking is an average over groups that differ, and among non-Hispanic Black adults it is not detectable. The survey places a respondent by state and nothing finer, so the chapter says nothing about neighborhoods.

Chapter 7.3, Multiple chronic conditions asks which chronic conditions are high in the same neighborhoods. Tracts in the most deprived tenth are high on more of the nine conditions it counts than tracts in the least deprived tenth, and the conditions move together across tracts, partly because the model behind every estimate shares its inputs. It is a chapter about places and says nothing about how many conditions one person has.

Chapter 7.4, Disability, retirement and Medicare finds that adult disability rises with tract deprivation, that disabled workers are a larger share of Social Security beneficiaries in more deprived ZIP codes, and that the size of a retired worker's benefit follows ZIP code income. Medicare payments per fee-for-service beneficiary show no detectable difference between the least and the most deprived fifths of counties, although the mix of services behind the total differs. The fifths differ in county size, which the chapter shows separately, and the payments are not adjusted for how sick beneficiaries are, so equal payments do not mean equal need or equal care. The last section compares how much the expected age at death of the poorest and the richest income quartiles varies across counties, a comparison that depends on how counties are weighted, and the chapter reports it both ways.

A box in the chapter reports studies of what Medicare eligibility, disability allowance and a Social Security benefit notch changed for the people they reached. Those designs estimate what a program changes at a threshold or on the margin of a decision, and none of them estimates whether the programs would narrow the differences between places that the rest of the chapter describes.