Article

Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults

Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass 02115, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 09/2003; 290(6):757-64. DOI: 10.1001/jama.290.6.757
Source: PubMed

ABSTRACT Uninsured adults receive less appropriate care and have more adverse health consequences than insured adults. Longitudinal studies would help to more clearly define the effects of health insurance on health care and health.
To assess the differential effects of gaining Medicare coverage on use of basic clinical services and medications by previously insured and uninsured adults.
Household survey data from the nationally representative Health and Retirement Study were used to analyze differences in receipt of basic clinical services by adults in 1996 and 2000, before and after becoming eligible for Medicare at age 65 years.
A total of 2203 adults aged 60 to 64 years in 1996 who were classified as continuously uninsured (n = 167), intermittently uninsured (n = 216), or continuously insured (n = 1820) in 1994 and 1996, prior to Medicare eligibility.
Individuals' reports of receiving cholesterol testing, mammography (in women), prostate examination (in men), and treatment of arthritis and hypertension in the prior 2 years.
The difference in cholesterol testing between continuously insured and continuously uninsured adults was significantly reduced after Medicare eligibility (35.4% vs 17.7%; change of -17.7% [95% CI, -29.3% to -6.2%]; P =.003), and the reduction was substantially greater among those with hypertension or diabetes than among other adults (29.2% vs 7.7%; difference of 21.5% [95% CI, 0.2% to 42.9%]; P =.048). Differences in use were similarly reduced after Medicare eligibility for mammography in women (30.3% vs 15.0%; change of -15.3% [95% CI, -29.9% to -0.7%]; P =.04) and prostate examination in men (45.2% vs 20.0%; change of -25.2% [95% CI, -45.4% to -5.1%]; P =.01). Continuously uninsured adults with arthritis reported significantly greater increases in arthritis-related medical visits and limitations of activity than continuously insured adults after Medicare eligibility, but not greater increases in arthritis treatments. Among adults with hypertension, differences in use of antihypertensive medications between continuously uninsured and insured adults were essentially unchanged after Medicare coverage.
Previously uninsured adults substantially increased their use of covered basic clinical services but not medications after gaining Medicare coverage. An affordable option through which near-elderly uninsured adults could purchase Medicare coverage might have similar effects.

1 Follower
 · 
125 Views
  • Source
    • "A signi…cant literature exists showing that when individuals have health insurance they increase their use of health care services (Decker and Rapaport, 2002; McWilliams et Al., 2003; Dow, 2004; Card, Dobkin and Maestas, 2008; McWilliams et Al., 2007), however it is unclear whether this increased utilization actually leads to an improvement in health outcomes. When the discontinuity in Medicare eligibility at age 65 is used to identify the impact of increased health care use on mortality, the results tend to show there is no e¤ect (Dow, 2004; Card, Dobkin and Maestas, 2004; Finklestein and McKnight, 2005). 1 With the exception of the Medicare discontinuity, establishing a causal relationship between health insurance and health outcomes has been di¢ cult as random variation in health insurance status is rarely observed (Levy and Meltzer, 2003). "
    [Show abstract] [Hide abstract]
    ABSTRACT: In the 1990s and early 2000s, a number of states passed laws requiring mental health benefits to be included in health insurance coverage. The variation in the characteristics and enactment date of the laws provides an opportunity to measure the impact of increasing access to mental health care on mental health outcomes, as evidenced by state suicide rates. In contrast with previous research, results show that when states enact laws requiring insurance coverage to include mental health benefits at parity with physical health benefits, the suicide rate decreases significantly by 5%. The findings are robust to a number of specifications and falsification tests. Copyright © 2011 John Wiley & Sons, Ltd.
    Health Economics 01/2013; 22(1). DOI:10.1002/hec.1816 · 2.14 Impact Factor
  • Source
    • "Much prior research on the impact of Medicare enrollment on health and utilization explicitly focuses on the effects of changes in insurance coverage status (Card et al., 2008; Lichtenberg, 2002; McWilliams et al, 2003; Polsky et al, 2009). Though the effect of insurance is likely a major contributor, the timing of this status change coincides with other potential effects that may also contribute to a rise in health care service use. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Delays in receipt of necessary diagnostic and therapeutic medical procedures related to the timing of Medicare initiation at age 65 years have potentially broad welfare implications. We use 2005-2007 data from Florida and North Carolina to estimate the effect of initiation of Medicare benefits on healthcare utilization across procedures that differ in urgency and coverage. In particular, we study trends in the use of elective procedures covered by Medicare to treat conditions that vary in symptoms; these are compared with elective surgical procedures not eligible for Medicare reimbursement, and to a set of urgent and emergent procedures. We find large discontinuities in health services utilization at age 65 years concentrated among low-urgency, Medicare-reimbursable procedures, most pronounced among screening interventions and treatments for minimally symptomatic disease.
    Health Economics 08/2012; 21(8):1030-6. DOI:10.1002/hec.1772 · 2.14 Impact Factor
  • Source
    • "Consistent with previous studies that acknowledge the importance of gaps in coverage (Short, and Graefe 2003) and coverage continuity (McWilliams et al. 2003), this study defined continuously insured as 90 days of self-reported coverage during an observation quarter, intermittently insured as 1–89 days and continuously uninsured as 0 days of coverage. To determine whether longer durations of insurance coverage affected health services and ART use, sequentially longer periods of observed coverage were tested for each outcome variable. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Health services research consistently confirms the benefit of insurance coverage on the use of health services sought in the USA. However, few studies have simultaneously addressed the multitude of competing and unmet needs specifically among unstably housed persons. Moreover, few have accounted for the fact that hospitalization may lead to obtaining insurance coverage, rather than the other way around. This study used marginal structural models to determine the longitudinal impact of insurance coverage on the use of health services and antiretroviral therapy (ART) among HIV-positive unstably housed adults. The impact of insurance status on the use of health services and ART was adjusted for a broad range of confounders specific to this population. Among 330 HIV-positive study participants, both intermittent and continuous insurance coverage during the prior 3-12 months had strong and positive effects on the use of ambulatory care and ART, with stronger associations for continuous insurance coverage. Longer durations of continuous coverage were less robust in affecting emergency and inpatient care. Race and ethnicity had no significant influence on health services use in this low-income population when confounding due to competing needs was considered in adjusted analyses. Given that ambulatory care and ART are factors with substantial potential impact on the course of HIV disease, these data suggest that securing uninterrupted insurance coverage would result in large reductions in morbidity and mortality. Health care policy efforts aimed at increasing consistent insurance coverage in vulnerable populations are warranted.
    AIDS Care 03/2011; 23(7):822-30. DOI:10.1080/09540121.2010.538660 · 1.60 Impact Factor
Show more

Preview

Download
2 Downloads
Available from

Alan M Zaslavsky