Drinking water quality impacts on health care expenditures in the United States

Abstract

This paper explores the relationship between episodes of contaminated drinking water and health care expenditures in the United States. The analysis relies on panel data from the 48 contiguous states from 2000 to 2011. We use the population served by public water systems that violate health-based standards of the Safe Drinking Water Act as a proxy for contaminated drinking water. We estimate spatial and non-spatial models and control for factors that may aect per capita health care expenditures including variables that reect air quality violations along with ability to pay plus demand for and supply of health care services. The results from a Spatial Durbin Model indicate that a 1% decrease in the percentage of population exposed to drinking water quality violations is associated with reductions in in-state and regional eects equal to 0.005% ($0.32) and 0.035% ($2.26) of per capita health care expenditures, respectively. Drinking water violations have a larger impact on expenditures than air quality violations (whose eects are not statistically dierent from zero). However, compared to other factors, such as Medicare enrollment and income, the impact of these violations on health care expenditures is relatively small. We nd that regional health care expenditure impacts from drinking water violations are substantially greater than in-state impacts. Thus, a regional approach is recommended to addressing drinking water quality improvements.

Evaluating the Role of GDPPer Capita, Air Pollution and Non‐Economic Factors in Determining Health Expenditure: Evidence from Asian Region Using Instrumental Variables Techniques

“…Safe drinking water (lnsafedrinking) is positively connected with health expenditure; that is, 1 per cent increase in population served by safe drinking water system would increase per capita health expenditure by 0.112 per cent. The evidence is in line with the finding of Alzahrani et al (2019) on the United States.…”

“…Our outcome supports the finding of Alzahrani et al . (2019) that greater supply of healthcare services increases their demand that led to higher healthcare expenditure. The elasticity of number of physicians (ln physicians ) with respect to health expenditure is negative and significant, which indicates that increase in physicians per capita may improve the overall health of society that in turn decrease the cost of health in future (Samadi & Rad, 2013).…”

“…In a competitive market economy, an inverse relationship is expected between greater availability of healthcare services and health expenditure, and all other factors remain constant. However, empirical literature suggests that a greater supply of health care services increases their demand, which leads to higher healthcare expenditure (Alzahrani et al ., 2019).…”

Quantifying Disparities in Per- and Polyfluoroalkyl Substances (PFAS) Levels in Drinking Water from Overburdened Communities in New Jersey, 2019–2021

“…This is similar to studies that rely on SDWA violations or levels of other contaminants as a proxy for contamination, as researchers are often unable to directly measure PFAS exposure through drinking water consumption. 6 – 10 , 55 , 56 , 58 , 59 As a consequence of our approach, we are unable to interpret PFAS detections in drinking water as definite “exposure” to PFAS for several reasons.…”

Coagulation efficiency and removal mechanism for composite coagulant polyaluminium chloride/polydimethyldiallylammonium chloride in treating lightly micro-polluted raw water of Yangtze River in autumn

“…As a commonly used treatment method, the application of inorganic coagulants, such as aluminium and iron salts at controlled pH, has been used to improve the supernatant water quality, while using turbidity as the main control parameter. As a result, excess inorganic coagulant dosage has introduced the problem of not only increased treatment cost, but also residual aluminium and iron content that has exceeded maximum allowable limits set by the World Health Organization for drinking water (WHO, 2008;Yang et al, 2013;Alzahrani et al, 2020). Treatment methods for lightly micropolluted raw water may also involve pre-oxidation and technologies such as enhanced coagulation, and advanced treatment technology or using membrane and advanced oxidation processes in combination with conventional treatment methods such as coagulation, sedimentation, filtration and disinfection (Yu and Graham, 2015;Brandt et al, 2017;Nascimento et al, 2019;Adebayo et al, 2021).…”