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Medicare and Disparities in Women's Health


  • Sandra Decker
  • Carol Rapaport


We investigate the effect of universal health insurance on health outcome and the use of health services by exploiting a natural experiment that changes the insurance status of most Americans at age 65; that is, eligibility for the U.S. Medicare program. We compare inequalities in health and health care use just before and after the age of universal Medicare coverage (65) in the United States. We focus in this paper on the use of services related to breast cancer. We test whether Medicare improves the use of early detection services and ultimately stage of diagnosis of breast cancer particularly for groups shown to be more likely to be uninsured prior to age 65, such as black women or women with less than a high school education. Our results show that education differences in mammography and breast exam receipt and ultimately in stage of diagnosis of breast cancer lessen after the age of 65 for white women. We also find that turning 65 significantly increases the chance that a black woman, especially a less educated black woman, has had a mammogram. We do not find comparable evidence that stage of diagnosis is improved for black women after the age of 65.

Suggested Citation

  • Sandra Decker & Carol Rapaport, 2002. "Medicare and Disparities in Women's Health," NBER Working Papers 8761, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:8761
    Note: HC

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    References listed on IDEAS

    1. Deaton, Angus S & Paxson, Christina H, 1998. "Aging and Inequality in Income and Health," American Economic Review, American Economic Association, vol. 88(2), pages 248-253, May.
    2. Hurd, Michael D. & McGarry, Kathleen, 1997. "Medical insurance and the use of health care services by the elderly," Journal of Health Economics, Elsevier, vol. 16(2), pages 129-154, April.
    3. Arline Geronimus & John Bound, 1990. "Black/white differences in women’s reproductive-related health status: evidence from vital statistics," Demography, Springer;Population Association of America (PAA), vol. 27(3), pages 457-466, August.
    4. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, January.
    5. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    6. Sandra L. Decker & Carol Rapaport, 2002. "Medicare And Inequalities In Health Outcomes: The Case Of Breast Cancer," Contemporary Economic Policy, Western Economic Association International, vol. 20(1), pages 1-11, January.
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    Cited by:

    1. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    2. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, Oxford University Press, vol. 124(2), pages 597-636.
    3. David Card & Carlos Dobkin & Nicole Maestas, 2004. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization and Health: Evidence from Medicare," NBER Working Papers 10365, National Bureau of Economic Research, Inc.
    4. David Card & Carlos Dobkin & Nicole Maestas, 2007. "The Impact of Health Insurance Status on Treatment Intensity and Health Outcomes," Working Papers WR-505, RAND Corporation.
    5. McGarry, Kathleen, 2002. "Public Policy and the U.S. Health Insurance Market: Direct and Indirect Provision of Insurance," National Tax Journal, National Tax Association, vol. 55(4), pages 789-827, December.

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