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International journal of health care finance and economics, v.4 no.1, 2004년, pp.43 - 63
Picone, Gabriel (Department of Economics, University of South Florida. gpicone@coba.usf.edu) , Brown, Derek (Department of Economics, Duke University. dsb3@duke.edu) , Sloan, Frank (Department of Economics, Duke University and NBER. fsloan@hpolicy.duke.edu) , Lee, Paul (Department of Ophthamology, Duke University Medical Center)
We use a longitudinal national sample of Medicare claims linked to the National Long-Term Care Survey (NLTCS) to assess the productivity of routine eye examinations. Although such exams are widely recommended by professional organizations for certain populations, there is limited empirical evidence on the productivity of such care. We measure two outcomes, the ability to continue reading, and no onset of blindness or low vision, accounting for potential endogeneity of frequency of eye exams. Using instrumental variables, we find a statistically significant and beneficial effect of routine eye exams for both outcomes. Marginal effects for reading ability are large, but decline in the number of years with eye exams. Effects for blindness/low vision are smaller for the general elderly population, but larger for persons with diabetes. Instrumental variables provide a useful approach for assessing the productivity of particular interventions, particularly in situations in which randomized controlled trials are expensive or perhaps unethical and difficult to conduct over a lengthy time period.
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