title: Can patient self-management explain the health gradient? Goldman and Smith's "Can patient self-management help explain the SES health gradient?" (2002) revisited.
abstract: In their much-cited paper, "Can patient self-management help explain the SES health gradient?"Goldman and Smith (2002) use samples of diabetic and HIV+ patients in the United States to conclude that disease self-management is an important explanation for the much-documented positive gradient in education and health outcomes. In this paper, I revisit their analysis and point to some fundamental difficulties in interpreting their results as conclusive evidence in favor of self-management. I also argue that for individuals for whom self-management might be expected to matter -i.e. populations of patients managing complex conditions - economic factors such as resource availability and insurance access might be a more important mechanism behind the gradient than medical compliance. The impact of self-management, though it might matter, is likely to be small.
authors.affiliation: Economics, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3. smaitra@econ.yorku.ca
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Maitra
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000628:therapy*; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D012959:Socioeconomic Factors