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Medicare News
Senior Citizens in Medicare Prove Health Improves
with Universal Health Insurance
Those without prior insurance show greatest health
gains after reaching Medicare coverage
Dec. 26, 2007 – As the presidential candidates rush
out their ideas on universal health care, a new study of senior citizens
proves just how valuable it can be to extend health coverage to those
that do not have it. The report published today in the Journal of the
American Medical Association (JAMA) looks at the impact of Medicare,
which provides comprehensive evidence that having health insurance leads
to better health.
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“This study provides strong evidence about how
health improves when people gain insurance coverage,” says Dr. John
Ayanian, senior author and Professor of Health Care Policy and Medicine
at Harvard Medical School and Brigham and Women’s Hospital.
“For every 100 uninsured people with heart disease
or diabetes before age 65, we found that with Medicare coverage they had
10 fewer major cardiac complications, such as heart attacks or heart
failure, than expected by age 72,” he adds.
The study was funded by The Commonwealth Fund.
In order to provide a macro-view on the health
effects of gaining insurance coverage, Ayanian, lead author Dr. J.
Michael McWilliams, a research associate in Harvard Medical School’s
Department of Health Care Policy and Brigham and Women’s Hospital, and
Harvard colleagues assessed data from the Health and Retirement Study,
an ongoing longitudinal survey of aging Americans sponsored by the
National Institute on Aging.
The researchers analyzed survey data collected from
7,233 participants every two years from 1992 through 2004, and examined
their health from age 55 to 72. Among these individuals, 5,006 were
continuously insured, while 2,227 were either persistently or
intermittently uninsured until they qualified for Medicare at age 65.
“While it may seem self-evident that gaining health
insurance should improve health, some experts have questioned this
assumption,” says McWilliams.
“By comparing the health trends of insured and
uninsured adults as they became eligible for Medicare, we were able to
measure the impact of coverage on health in a more rigorous way.”
During this 12-year period, participants were asked
to comprehensively report their health across a series of dimensions,
including overall health, physical functioning (such as ability to climb
stairs or walk certain distances), bodily pain, depression, and
cardiovascular outcomes including heart attacks or strokes.
Individuals with continuous coverage did not report
a significant change in their health as they transitioned to Medicare,
but those who had little or no prior coverage reported substantial
improvements in their health trends.
“Uninsured near-elderly adults, particularly those
with cardiovascular disease or diabetes, experience worse health
outcomes and use more health services as Medicare beneficiaries after
age 65 years than insured near-elderly adults. Because chronic diseases
are prevalent and insurance coverage is often unaffordable for older
uninsured adults, the impact of near-universal Medicare coverage at age
65 years on the health of previously uninsured adults may be
substantial,” the authors write.
The impact of coverage was greatest for those with
a history of heart disease, stroke, high blood pressure, or diabetes.
Participants with these conditions who lacked insurance experienced a
steeper decline in health compared to their insured counterparts prior
to age 65. But after five years of Medicare coverage this health gap
closed by 50 percent.
“Forty-seven million people are currently without
health insurance in the United States,” said Sara Collins, Ph.D.,
assistant vice president at the Commonwealth Fund. “The findings of this
study underscore the urgency of health reform efforts to provide health
insurance to the full population.”
“Our findings have important policy implications.
Proposals to extend insurance coverage to uninsured near-elderly adults
have been introduced in the U.S. Congress and endorsed by the American
College of Physicians. Providing earlier health insurance coverage for
uninsured adults, particularly those with cardiovascular disease or
diabetes, may have considerable social and economic value for the United
States by improving health outcomes,” the authors conclude.
These findings build upon an earlier study by the
same authors last July, also funded by the Commonwealth Fund. In that
paper, published in the New England Journal of Medicine, the authors
showed that uninsured adults transitioning to Medicare end up costing
the system more in annual medical spending after 65 compared with
continuously insured individuals.
“Together, the two studies suggest that expanding
health coverage is less costly than previously believed and slows
declines in health as well,” says Ayanian.
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