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

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Author Info
David Card
Carlos Dobkin
Nicole Maestas

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Abstract

The authors 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 theprobability of routine doctor visits. Hospital discharge records also show large increases inadmission 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 ofthe 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 they find no evidence of a shift in the rate of growth of mortality rates at age 65.

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Paper provided by RAND Corporation Publications Department in its series Working Papers with number 197.

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Length: 74 pages
Date of creation: Oct 2004
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Handle: RePEc:ran:wpaper:197

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Find related papers by JEL classification:
I12 - Health, Education, and Welfare - - Health - - - Health Production
I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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  1. Hong Wang & Winnie Yip & Licheng Zhang & William C. Hsiao, 2009. "The impact of rural mutual health care on health status: evaluation of a social experiment in rural China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages S65-S82. [Downloadable!]
  2. Guido Imbens & Thomas Lemieux, 2007. "Regression Discontinuity Designs: A Guide to Practice," NBER Technical Working Papers 0337, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  3. Amy Finkelstein & Robin McKnight, 2005. "What Did Medicare Do (And Was It Worth It)?," NBER Working Papers 11609, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  4. Ofer Malamud & Cristian Pop-Eleches, 2008. "General Education vs. Vocational Training: Evidence from an Economy in Transition," NBER Working Papers 14155, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  5. Inas Rashad & Sara Markowitz, 2007. "Incentives in Obesity and Health Insurance," NBER Working Papers 13113, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  6. Denise Doiron & Glenn Jones & Elizabeth Savage, 2006. "Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance, CHERE Working Paper 2006/2," Working Papers 2006/2, CHERE, University of Technology, Sydney. [Downloadable!]
  7. Robert E. Hall & Charles I. Jones, 2005. "The value of life and the rise in health spending," Proceedings, Federal Reserve Bank of San Francisco. [Downloadable!]
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  8. Denise Doiron & Glenn Jones & Elizabeth Savage, 2008. "Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 317-334. [Downloadable!]
  9. Michael Greenstone & Ted Gayer, 2007. "Quasi-Experimental and Experimental Approaches to Environmental Economics," Working Papers 0713, Massachusetts Institute of Technology, Center for Energy and Environmental Policy Research. [Downloadable!]
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  10. David Card & Carlos Dobkin & Nicole Maestas, 2007. "Does Medicare Save Lives?," NBER Working Papers 13668, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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