title: The health effects of Medicare for the near-elderly uninsured.
abstract: OBJECTIVE
  To determine whether Medicare enrollment at age 65 has an effect on the health trajectory of the near-elderly uninsured.
  
  
  METHODS
  Eight biennial waves (1992-2006) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61 year olds and their spouses.
  
  
  METHODS
  We use a quasi-experimental approach to compare the health effects of insurance for the near-elderly uninsured with previously insured contemporaneous controls. The primary outcome measure is overall self-reported health status combined with mortality (i.e., excellent to very good, good, fair to poor, dead).
  
  
  RESULTS
  The change in the trajectory of overall health status for the previously uninsured that can be attributed to Medicare is small and not statistically significant. For every 100 persons in the previously uninsured group, joining Medicare is associated with 0.6 fewer in excellent or very good health (95 percent CI: -4.8, 3.3), 0.3 more in good health (95 percent CI: -3.8, 4.1), 2.5 fewer in fair or poor health (95 percent CI: -7.4, 2.3), and 2.8 more dead (-4.0, 10.0) by age 73. The health trajectory patterns from physician objective health measures are similarly small and not statistically significant.
  
  
  CONCLUSIONS
  Medicare coverage at age 65 for the previously uninsured is not linked to improvements in overall health status.
authors.affiliation: Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. polsky@mail.med.upenn.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
authors.forename: José
authors.initials: J
authors.lastname: Escarce
authors.forename: Willard
authors.initials: W
authors.lastname: Manning
authors.forename: Susan M
authors.initials: SM
authors.lastname: Paddock
authors.forename: Liyi
authors.initials: L
authors.lastname: Cen
authors.forename: Jeannette
authors.initials: J
authors.lastname: Rogowski
mesh_terms: D000368:Aged; D001294:Attitude to Health; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage / Q000458:organization & administration*; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000523:psychology / Q000706:statistics & numerical data; D006278:Medicare / Q000458:organization & administration*; D009026:Mortality; D015999:Multivariate Analysis; D015397:Program Evaluation; D012179:Retirement / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D014481:United States / Q000453:epidemiology
references.citation: Milbank Q. 2000;78(2):291-321, 151-2
references.pmid: 10934995
references.citation: JAMA. 2003 Aug 13;290(6):757-64
references.pmid: 12915428
references.citation: JAMA. 2007 Dec 26;298(24):2886-94
references.pmid: 18159058
references.citation: N Engl J Med. 1984 Aug 16;311(7):480-4
references.pmid: 6379458
references.citation: Inquiry. 1994-1995 Winter;31(4):425-37
references.pmid: 7821996
references.citation: JAMA. 1993 Feb 10;269(6):787-92
references.pmid: 8423663
references.citation: JAMA. 1993 Aug 11;270(6):737-41
references.pmid: 8336376
references.citation: J Health Econ. 2005 Jan;24(1):137-60
references.pmid: 15617792
references.citation: Arch Intern Med. 2005 Apr 11;165(7):770-6
references.pmid: 15824296
references.citation: J Gen Intern Med. 2006 Mar;21(3):267-75
references.pmid: 16336622
references.citation: N Engl J Med. 2001 Oct 11;345(15):1106-12
references.pmid: 11596591
references.citation: N Engl J Med. 2007 Jul 12;357(2):143-53
references.pmid: 17625126
references.citation: Am Econ Rev. 2008 Dec;98(5):2242-2258
references.pmid: 19079738
references.citation: Am Econ Rev. 1987 Jun;77(3):251-77
references.pmid: 10284091
references.citation: J Gen Intern Med. 1988 Jul-Aug;3(4):356-62
references.pmid: 3404297
references.citation: Health Serv Res. 2006 Apr;41(2):429-51
references.pmid: 16584457
references.citation: Health Serv Res. 2006 Apr;41(2):452-60; discussion 461-6
references.pmid: 16584458
references.citation: Health Serv Res. 2006 Jun;41(3 Pt 1):759-87
references.pmid: 16704511
references.citation: Arch Intern Med. 1994 Nov 14;154(21):2409-16
references.pmid: 7979836
references.citation: Med Care Res Rev. 2003 Jun;60(2 Suppl):3S-75S; discussion 76S-112S
references.pmid: 12800687
references.citation: Arch Intern Med. 2005 Nov 28;165(21):2537-8; author reply 2538
references.pmid: 16314554
references.citation: Health Aff (Millwood). 2005 Jan-Jun;Suppl Web Exclusives:W5-63-W5-73
references.pmid: 15689369
references.citation: Med Care Res Rev. 1998 Jun;55(2):177-210
references.pmid: 9615562