What happens when people who previously had no health insurance begin receiving Medicare at age 65? Does having health coverage mean these individuals use more medical services? If so, does that translate into improved health?
Several HCP researchers set out to answer these and other questions by examining data from surveys of previously uninsured adults who entered the Medicare system at 65. The research team includes J. Michael McWilliams, MD; Ellen Meara, PhD; Alan M. Zaslavsky, PhD; and John Z. Ayanian, MD, MPP. What they found is perhaps not surprising but provides compelling evidence about the importance of accessible health care—both for the patients themselves and for the nation's health care system.
The results of this research were recently published in the New England Journal of Medicine and the Journal of the American Medical Association and were widely covered in the national and international media (see media coverage links below).
Better care and better health
People over age 50 and under 65 who have no health insurance generally have more health problems and die at a younger age than their peers who have health insurance. Uninsured individuals who have cardiovascular disease or diabetes are especially likely to suffer adverse effects from a lack of health care, as preventive measures often provide important improvements in health for individuals with these conditions. Thus, when people without insurance reach 65 and enter the Medicare system, they may be in worse health and require more expensive medical care than their peers who had previously been insured.
The HCP researchers found that in fact previously uninsured adults—especially those with cardiovascular disease or diabetes—reported more visits to the doctor and more hospitalizations after 65 than did previously insured adults. Similarly, previously uninsured adults with these conditions reported higher total medical spending once they acquired Medicare coverage than did individuals with heart disease or diabetes who already had health insurance. Previously uninsured adults with these conditions also reported significantly greater improvements in their health in a number of areas than did previously insured adults. These results provide evidence of the long-term benefits of gaining insurance on the health of previously uninsured Medicare beneficiaries, particularly those with heart disease or diabetes.
Implications for health care policy
These findings have important policy implications. Providing health insurance coverage before age 65 for uninsured adults, particularly those with cardiovascular disease or diabetes, may lead to improvements in health and reduced health care use and spending in the first several years after these individuals turn 65 and receive Medicare. These benefits may be substantial, may partially offset the costs of expanding coverage, and could have considerable social and economic value for the nation.
This research was supported by the Commonwealth Fund. Read summaries of the NEJM study and the JAMA study on the Commonwealth Fund's website.
Media coverage
Many media outlets—local, national, and international (including Australia, Canada, China, and India)—covered these HCP studies. The New York Times ran stories on each study (NEJM and JAMA), as well as an editorial on the latter. Additional coverage of the NEJM study included stories in Reuters, Bloomberg news, the Washington Post, and Harvard Medical School's Focus. Reporting on the JAMA article included the Washington Post, Wall Street Journal, Heartwire, and CBS News. Also read the Harvard Medical School press release.
Listen to an interview with Ayanian about the results of this research and Medicare Part D at the Annals of Internal Medicine.
