Health Insurance Medicare

How does gaining Medicare coverage affect healthcare utlization?

According to an article by Decker, Doshi, Knaup and Polsky (2012), the answer is that Medicare health insurance increases utilization among the uninsured, but the utilization of medical services does not rise to the same level as those who previously had insurance.

Although we do not find statistically significant differences in Medicare expenditures or in the number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 years continue to use the healthcare system differently from those who were privately insured. Specifically, they have 16% fewer visits to office-based physicians but make 18% and 43% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured seem to continue to use the healthcare system differently from the previously insured.

This could be the case that uninsured have a strong preference towards less invasive medical care or it could be the case that the risk adjustment for patient health status was imprecise.  The authors control for health status on a 5-point Likert scale and also include comorbidities for depression, arthritis, cancer, diabetes, heart problems, high blood pressure, lung disease, or psychiatric problem; ADLs; IADLs; smoking status, and and drinking frequency, but other comorbidities could also affect utilization as well.

This study may be good new for the Health Insurance Exchanges.  Premiums in the exchange will be lower if previously-uninsured individuals continue to use relatively fewer services than previously-insured individuals once they join the exchange.


The authors use data from the Health and Retirement Study (HRS) linked to Medicare claims data.  Instructions for accessing this unique data set are available on the HRS website.



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