title: Medicare eligibility and physician utilization among adults with coronary heart disease and stroke.
abstract: BACKGROUND
  Although Medicare eligibility has been shown to generally increase health care access and utilization, few studies have investigated the association between Medicare eligibility and health care utilization among the chronically ill.
  
  
  OBJECTIVE
  This study examines changes in health care access and utilization associated with Medicare eligibility among adults with coronary heart disease and stroke (CHDS).
  
  
  METHODS
  Descriptive statistics and regression discontinuity analysis were used to examine health care access and utilization at age 65 when Medicare eligibility begins for 176,611 National Health Interview Survey respondents aged 55-74 surveyed between 1997 and 2010.
  
  
  RESULTS
  We found that adults with CHDS reported a higher propensity to make 1+ office-based physician visits at age 65 (1.7%, P = 0.03) than adults with no major chronic disease (0.5%, P = 0.07). Adults with CHDS also reported greater reductions in cost as a barrier to care at age 65 (-3.6%, P < 0.01) than adults with no major chronic disease (-2.0%, P = 0.01). The subgroup analysis revealed that Hispanics and highly educated adults with CHDS reported the highest propensity to make 2+ office visits at age 65 (9.5%, P = 0.04 and 2.4%, P < 0.01). However, blacks with CHDS reported a decline in their propensity to make 2+ office visits at age 65 (-2.1%, P = 0.05).
  
  
  CONCLUSIONS
  Medicare eligibility improves health care access and utilization for many adults with CHDS, but it may not promote appropriate levels of physician use among some groups.
authors.affiliation: Department of Economics MS-22, Rice University, Houston, TX 77251-1892, USA. jerome.dugan@rice.edu
authors.forename: Jerome
authors.initials: J
authors.lastname: Dugan
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: Vivian
authors.initials: V
authors.lastname: Ho
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D004608:Eligibility Determination; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology