The Stanford Center on the Demography and Economics of Health and Aging (CDEHA) was established in 1999 to promote the study of trends in the demography, economics, health, and health care of the elderly. It has proven to be an invaluable resource at Stanford and has been a focal point for diverse new efforts in these areas. We have expanded and modified our original four theme areas proposed to reflect the interests of a growing community of investigators and to address new research challenges. Our themes are now:

1. Effects of medical technology and health care decisions on costs, health outcomes, and well-being of the elderly

2. Longitudinal and cohort studies of medical care, costs, and health and economic outcomes of older populations, in the United States and other countries, with particular emphasis on economic and health disparities

3. The interrelationships of health characteristics, economic status, functional status, and health care throughout the life cycle

4. Comparative international studies of demography, health, health care, and health policy affecting the aged, including analysis of health system efficiency in addressing the health care needs of the elderly

The first theme area, effects of medical technology and health care decisions on costs, outcomes, and well-being of the elderly, addresses some of the most important issues in the health of the elderly. The effects of specific health interventions are coming under increasing scrutiny, stimulated by the rapid and accelerating rate of introduction of apparently effective new technologies, and the consequent rise in expenditures. Rigorous evaluation of these technologies is required to balance the often competing goals of limiting expenditures and ensuring the availability of appropriate medical interventions. Since CDEHA began, this theme has evolved to include both physical and psychological considerations.

The second theme area encompasses longitudinal and cohort studies of medical care, costs, and health and economic outcomes of older populations. This theme is complementary to the first theme area, and also reflects a major focus of many affiliated researchers. Based primarily on the analysis of large longitudinal databases such as Medicare claims files, it seeks to determine which practice patterns, modes of organizing care, and features of health systems are associated with variation in costs and outcomes.

The third theme area, life cycle interrelationships of health characteristics and economic and functional status, concerns many pressing public policy issues. Studies in this area include the effects of non-elderly disability trends on old-age functional status and consequent burdens on health spending for the elderly. They also address the effects of obesity on employer-sponsored health insurance and wages.

The fourth theme area, international population studies, focuses particularly on joint work with collaborators in developed countries and China. Ongoing studies seek to anticipate the effects of demographic change on the viability of income support and other policies affecting the elderly.

CDEHA’s research themes complement those of centers that focus on traditional and economic demography. The Center distributes seed grants, supports supplemental analyses, and has developed a global research network to stimulate research in the four theme areas. Specific areas of research that reflect the strengths and interests of Stanford researchers and their collaborators have included long-term care, health disparities, the psychology of aging, cost-effectiveness of medical procedures for the elderly, disability trends throughout the life cycle, and international kin networks.

CDEHA’s relatively small size and its ability to draw upon expertise throughout Stanford University and affiliated institutions allows it to respond quickly to emerging research opportunities. The breadth of expertise within the Center permits projects to attract researchers from diverse academic disciplines to conduct original research that addresses policy issues relevant to the United States and many other nations. Traditional population studies, while not the chief focus of CDEHA, remains at the foundation of many of our efforts.

Elements of the Center Program:

Seed grants are intended to stimulate interest in aging research and enable investigators to turn nascent ideas into fully developed research programs appropriate for long-term, traditional National Institutes of Health (NIH) funding mechanisms. Seed grants are typically awarded for one to two years, to teams consisting of junior investigators (either advanced trainees or junior faculty) and senior faculty, who serve as mentors. Their support has enabled junior investigators to conduct research on important topics of aging, such as racial and gender differences in the use of cardiovascular procedures, and factors affecting health insurance plan choice among the elderly.

CDEHA also enables affiliated researchers to receive supplemental grants that support collaboration with other institutions, and that help develop and promote the use of new data sets. Supplementary funding has also been be used to support research efforts that are not suitable for the seed grant program. Six supplemental grants have been awarded by the National Institute on Aging (NIA) to junior and established researchers under CDEHA and have included examination of the impact of race and socioeconomic status on health disparities and investigation of the effects of HIV screening in the elderly.

CDEHA’s third major area of activity is the promotion of global research. Our researchers have designed and conducted comparative international analyses on areas of growing importance to aging populations, including long-term care utilization, health system productivity in chronic disease management, and trends in disability throughout the life cycle. Several research projects from our international collaboration were presented at the 2003 meeting of the International Health Economics Association.

Distinctive Aspects of the Center:

Medical Expertise--CDEHA integrates technical details of health and medical care into its research program. This capacity is the result of the core involvement of clinicians with broad and deep research experience, and advanced degrees in economics, health services research, and other fields. Many investigators are medical doctors specializing in areas important to the elderly, ranging from general geriatrics to cardiovascular disease to the growing concerns of Alzheimer’s disease and HIV among the aged. CDEHA is positioned to make unique contributions by bringing expertise in health and medical care to bear on questions in economics and demography, such as outcome differentials in physical functioning among the elderly in different socioeconomic circumstances.

Data Resources--Data sets include longitudinal and cross-sectional micro-data from many US agencies and international statistical offices. Collections are updated regularly with additional years of data (or additional waves), supplements, and documentation. Our primary data collection efforts include micro-data on Internet use and health, and on functional status of the elderly.

Research Setting--CDEHA is administered jointly by the Center for Health Policy (CHP) and the Center for Primary Care and Outcomes Research (PCOR) at Stanford University. CDEHA Principal Investigator (PI) Alan Garber is the Director, and CDEHA Project Director Kathryn M. McDonald is Executive Director of the two Centers. Established in 1997, CHP and PCOR are dedicated to education and rigorous investigation to guide health policy and clinical practices. CHP is a unit of Stanford's Institute for International Studies (SIIS); PCOR is part of Stanford University's School of Medicine. The centers have distinct research foci but they are administered and housed together, and share many staff. CHP conducts interdisciplinary research in such areas as comparative health care systems and epidemiology, health care financing, health expenditure forecasting, the effects of the legal and regulatory environment, and managed care and the effects of structural changes in the health care market. PCOR conducts research relevant to patient care, conducted by clinically active researchers organized into the areas of medical technology assessment, the advancement of primary care policy and practice, clinical decision making and practice guideline development, and medical outcomes.

Training Coordination--The rich training environment at Stanford provides recruitment sources for students and postdoctoral fellows who actively participate in CDEHA activities. Within CHP/PCOR, training programs include the Health Care Research and Policy Fellowship for pre- and post-doctoral trainees (most of whom have M.D. degrees when entering the program) sponsored by the Agency for Healthcare Research and Quality (AHRQ). The Veterans Affairs Ambulatory Care and Health Services Research Fellowships, open to physicians, Ph.D. candidates, and post-doctoral trainees in health services research, are also located in CHP/PCOR. These programs provide either two or three years of training support. CDEHA is also the "parent" grant for Stanford’s International Clinical, Operational and Health Services Research and Training Award (ICOHRTA), which is entitled the "China-US Health and Aging Research Program." Dr. Garber is PI for the ICHORTA program, which is supported by a grant from the Fogarty International Center at NIH. This program allows one health services researcher from China each year to work and study at Stanford with the goal of advancing their research skills to enable them to advance their careers in health policy/health services-related work in China.

Stanford Resources:

Morrison Institute on Population and Resource Studies (MIPRS)
MIPRS is directed by CDEHA affiliate Marcus Feldman. The objective of the Institute is to lead this interdisciplinary study of population growth and its effects on social structures, national economies, resource availability, and the environment throughout the world. The three major facets to this endeavor--research, education, and contribution to the formation of policy--overlap in the major programs of the institute. MIPRS also sponsors lectures and seminars in demography and biodemography.

Stanford Institute for International Studies (SIIS)
SIIS is dedicated to issues of international security, the global environment, international political economy, health-care policy, and democracy building and the rule of law in developing and transitional societies. The Institute draws together more than 150 Stanford faculty members, researchers, and visiting scholars through its research centers, projects, and programs. The constituent centers of SIIS are the Asia/Pacific Research Center, the Center on Democracy, Development and the Rule of Law, the Center for Environmental Science and Policy, and the Center for International Security and Cooperation, in addition to CHP.
Stanford Institute for Economic Policy Research (SIEPR)
Researchers at SIEPR study economic policy issues and enjoy close relationships with policy makers and the business community. They have a distinguished board of advisors and promote the involvement of the Stanford community in economic policy research. Programs include the Stanford Center for International Development, the Center on Employment and Economic Growth, and the Center for Public and Private Finance. SIEPR is led by CDEHA faculty affiliate John Shoven; CDEHA faculty mentor and affiliate Thomas MaCurdy is a Senior Fellow at SIEPR.
Local Research Affiliates:

The Veterans Affairs Palo Alto Care System (VAPAHCS), a research flagship of the VA system, is closely affiliated with the School of Medicine and is a major resource for PCOR. Many core and affiliated PCOR faculty have appointments at VAPAHCS and work closely with the VA's Center for Health Care Evaluation. Several PCOR research projects are conducted at the VA, including a multi-year study on policy modeling for AIDS and drug abuse, led by CHP/PCOR core faculty member Douglas Owens.

The Health Economics Research Center (HERC) is also part of the VAPAHCS, and is directed by CHP/PCOR affiliate Paul G. Barnett. HERC is a national center that assists VA researchers in assessing the cost-effectiveness of medical care and evaluating the efficiency of VA programs and providers through average cost, micro-cost, cost function, direct measurement, and decision support systems. CDEHA seed grantee Todd H. Wagner, and CHP/PCOR affiliates Mark W. Smith and Wei Yu, are all health economists at HERC. Clinical consultants for HERC include CDEHA PI Alan Garber, and CHP/PCOR core faculty members Douglas Owens and Mary K. Goldstein.

The National Bureau of Economic Research (NBER) has its West Coast office at Stanford. Dr. Garber is director of the NBER’s Health Care Program nationally. He and several CDEHA-affiliated economists are NBER Research Associates. CDEHA researchers have access to secure NBER computing facilities and data sets for approved projects, and research collaborations between the two offices are frequent and fruitful. For example, junior CDEHA researcher and seed grantee M. Kate Bundorf used Medicare Current Beneficiary Survey (MCBS) data housed at NBER to conduct analyses on health plan switching behavior among the elderly as part of her CDEHA pilot research.

Supported by funding from the National Institute on Aging (NIA)
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