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The Impact of Nearly Universal Insurance Coverage on Health Care Utilization and Health: Evidence from Medicare

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  • David Card
  • Carlos Dobkin
  • Nicole Maestas

Abstract

We use the increases in health insurance coverage at age 65 generated by the rules of the Medicare program to evaluate the effects of health insurance coverage on health related behaviors and outcomes. The rise in overall coverage at age 65 is accompanied by a narrowing of disparities across race and education groups. Groups with bigger increases in coverage at 65 experience bigger reductions in the probability of delaying or not receiving medical care, and bigger increases in the probability of routine doctor visits. Hospital discharge records also show large increases in admission rates at age 65, especially for elective procedures like bypass surgery and joint replacement. The rises in hospitalization are bigger for whites than blacks, and for residents of areas with higher rates of insurance coverage prior to age 65, suggesting that the gains arise because of the relative generosity of Medicare, rather than the availability of insurance coverage. Finally, there are small impacts of reaching age 65 on self-reported health, with the largest gains among the groups that experience the largest gains in insurance coverage. In contrast we find no evidence of a shift in the rate of growth of mortality rates at age 65.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 10365.

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Date of creation: Mar 2004
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Handle: RePEc:nbr:nberwo:10365

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  1. Timothy Waidmann & John Bound & Michael Schoenbaum, 1995. "The Illusion of Failure: Trends in the Self-Reported Health of the U.S. Elderly," NBER Working Papers 5017, National Bureau of Economic Research, Inc.
  2. Crossley, Thomas F. & Kennedy, Steven, 2002. "The reliability of self-assessed health status," Journal of Health Economics, Elsevier, vol. 21(4), pages 643-658, July.
  3. Frank R. Lichtenberg, 2002. "The Effects of Medicare on Health Care Utilization and Outcomes," NBER Chapters, in: Frontiers in Health Policy Research, Volume 5, pages 27-52 National Bureau of Economic Research, Inc.
  4. Anne Case & Angus Deaton, 2004. "Broken down by work and sex: how our health declines," Working Papers 257, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  5. John Bound, 1991. "Self-Reported Versus Objective Measures of Health in Retirement Models," Journal of Human Resources, University of Wisconsin Press, vol. 26(1), pages 106-138.
  6. David H. Autor & Mark G. Duggan, 2003. "The Rise In The Disability Rolls And The Decline In Unemployment," The Quarterly Journal of Economics, MIT Press, vol. 118(1), pages 157-205, February.
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