1. Floridian Exceptionalism Why do elderly Floridians use more health care services than their peers in the other states and have lower mortality rates? Victor R. Fuchs content.healthaffairs.org/cgi/ reprint/hlthaff.w3.357v1.pdf

2. Utilization and Mortality Elderly Floridians use much more medical care and have much lower mortality rates than do their peers in other regions of the country. After demographic and other variables are controlled for, the differential between Florida and the rest of the United States is 25% for utilization and 10% for mortality among whites ages 65–84.

4. Higher Utilization. Why? Physician Induced Demand? –Correlation does not prove causation! –the excess utilization; it is far in excess of any reasonable response to excess supply. In earlier studies Fuchs found that the elasticity of demand with respect to independent differences in supply is somewhere between 0.25 and 0.50. Thus, for physician inducement to explain an increase in utilization of 25 percent, there would have to be an independent increase in supply of 50–100 percent. –Increases of this magnitude seem implausible. Differences in Preferences?

5. Lower Mortality. Why? Selective in-migration – Healthier people move in. Selective out-migration – Less healthy move out. Florida’s benign climate. More social interaction.

6. Greater use of medical care? Greater use of medical care by Florida elderly is. A well-established fact. Could greater utilization explain lower mortality? Fuchs doubts it because it has always been difficult to show that differences in availability or use of medical care across areas of the country has much if any favorable effect on mortality. Compare areas that differ in population size. Utilization (especially outpatient) is substantially higher for white elderly residents of large MSAs than for those in small towns or rural areas (controlling for region, socioeconomic, and other variables), but mortality is slightly higher in the large MSAs.