title: Insurance disruption due to spousal Medicare transitions: implications for access to care and health care utilization for women approaching age 65.
abstract: OBJECTIVE
  To assess whether a husband's Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status.
  
  
  METHODS
  Respondents were married women under age 65 from the 2003-2005 round of the Wisconsin Longitudinal Study (N=655).
  
  
  METHODS
  Instrumental variable (IV) linear and IV-probit analyses provided unbiased estimates of the effect of an insurance disruption on study outcomes. The instrument was the husband's age: (1) women with husbands who transitioned to Medicare within the previous year (age 65-66); (2) women with husbands who did not transition (60<age<65).
  
  
  METHODS
  Respondents were surveyed via telephone and mail.
  
  
  RESULTS
  After adjustment, women who experienced an insurance disruption due to their husband's Medicare transition had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.
  
  
  CONCLUSIONS
  Despite consistent insurance coverage, the insurance disruption that accompanies a spouse's Medicare transition has adverse access and health care utilization consequences for women.
authors.affiliation: Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53726, USA. jrschumacher@wisc.edu
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Schumacher
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
authors.forename: Jinn-Ing
authors.initials: JI
authors.lastname: Liou
authors.forename: Nancy
authors.initials: N
authors.lastname: Pandhi
mesh_terms: D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D005260:Female; D006264:Health Benefit Plans, Employee / Q000458:organization & administration; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000458:organization & administration*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000458:organization & administration*; D008875:Middle Aged; D015999:Multivariate Analysis; D012959:Socioeconomic Factors; D018454:Spouses; D014481:United States; D014922:Wisconsin; D014930:Women / Q000523:psychology; D016387:Women's Health