Health Insurance and Health at Age 65: Implications for Medical Care Spending on New Medicare Beneficiaries

作者：Jack Hadley, Timothy Waidmann · 发表于：Health Services Research · 年份：2006 · DOI：10.1111/j.1475-6773.2005.00491.x · 被引用次数：87 · 研究领域：Healthcare Policy and Management、Global Health Care Issues、Financial Literacy, Pension, Retirement Analysis

OBJECTIVES: To investigate the consequences of endogeneity bias on the estimated effect of having health insurance on health at age 63 or 64, just before most people qualify for Medicare, and to simulate the implications for total and public insurance (Medicare and Medicaid) spending on newly enrolled beneficiaries in their first years of Medicare coverage. DATA: The longitudinal Health and Retirement Survey of people who were 55-61 years old in 1992, followed through biannual surveys to age 63-64 or until 2000 (whichever came first), and those who were 66-70 years olds from the Medicare Current Beneficiary Surveys, 1992-1998. STUDY DESIGN: Instrumental variable (IV) estimation of a simultaneous equation model of insurance choice and health at age 63-64 as a function of baseline health and sociodemographic characteristics in 1992 and endogenous insurance coverage over the observation period. FINDINGS: Continuous insurance coverage is associated with significantly fewer deaths prior to age 65 and, among those who survive, a significant upward shift in the distribution of health states from fair and poor health with disabilities to good to excellent health. Treating insurance coverage as endogenous increases the magnitude of the estimated effect of having insurance on improved health prior to age 65. The medical spending simulations suggest that if the near-elderly had continuous insurance coverage, average annual medical spending per capita for new Medicare beneficiaries in th...