The health effects of Medicare for the near-elderly uninsured.
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.
Polsky
Daniel
D
Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. polsky@mail.med.upenn.edu
Doshi
Jalpa A
JA
Escarce
José
J
Manning
Willard
W
Paddock
Susan M
SM
Cen
Liyi
L
Rogowski
Jeannette
J
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
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