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Association between Health Insurance and Health among Adults with Diabetes: Evidence from Medicare
Author(s) -
Lipton Brandy J.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16238
Subject(s) - medicine , medical expenditure panel survey , overweight , worry , confidence interval , gerontology , body mass index , national health interview survey , diabetes mellitus , health care , obesity , demography , health insurance , environmental health , population , psychiatry , anxiety , endocrinology , sociology , economics , economic growth
OBJECTIVES Gaining Medicare eligibility at age 65 is associated with increased health insurance coverage and reduced medical expenditure risk, but few studies have examined changes in health outcomes among adults with a specific chronic condition. This study assessed the association between Medicare eligibility and health among adults with diabetes. DESIGN Regression discontinuity design to test for discontinuities in healthcare outcomes at age 65 when most US adults become eligible for Medicare. SETTING National Health Interview Survey, 2006‐2016. PARTICIPANTS Respondents ages 55 to 74 with diagnosed diabetes (n = 13 455). MEASUREMENTS Primary outcome measures included self‐reported fair or poor general health status, any functional limitation, overweight, obese, and body mass index. Secondary outcomes included health insurance coverage, healthcare spending burden, and functional limitations by cause and type. RESULTS Medicare eligibility was associated with about an 8.0 percentage point reduction in the uninsured rate (95% confidence interval [CI], −9.9 to −6.0 percentage points; P < .001) and declines in high out‐of‐pocket healthcare expenditures and worry about medical bills. Eligibility was also associated with reductions of about 5.2 [95% CI, −6.9 to −3.6; P < .001] and 4.7 [95% CI, −7.1 to −2.3; P = .001] percentage points in fair or poor health and any functional limitation, respectively. Declines in functional limitations appeared to be driven by reductions in limitations due to diabetes, arthritis, heart problems, and emotional or behavioral problems. Some evidence indicated that Medicare eligibility was associated with a decline in obesity, but estimates were not consistently statistically significant. CONCLUSION Expanded health insurance coverage and gains in coverage quality may improve health outcomes among older adults with diabetes. J Am Geriatr Soc 68:388–394, 2020