Impact of Medicare on Utilization and Health Disparities

医疗保险对利用和健康差异的影响

• 批准号: 7092852
• 负责人: DAVID E. CARD
• 金额: $ 28.64万
• 依托单位: NATIONAL BUREAU OF ECONOMIC RESEARCH
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-06-15 至 2009-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7092852
• 关键词: African American; Hispanic Americans; Medicare /Medicaid; behavioral /social science research tag; caucasian American; family structure /dynamics; functional ability; health care service availability; health care service evaluation; health care service utilization; health disparity; health insurance; health services research tag; hospital utilization; human data; human mortality; human old age (65+); managed care; outcomes research; outpatient care; patient oriented research; quality of life; racial /ethnic difference

DESCRIPTION (provided by applicant): The Medicare program provides nearly universal health insurance coverage for the elderly. The onset of Medicare eligibility is associated with a drop in inter-group disparities in access to ambulatory care and a rise in hospital admission rates. Surprisingly, however, African Americans experience much smaller increases than whites in rates of hospitalization at age 65, and in rates for specific procedures including hip and knee replacements. Thus, Medicare appears to have an ambiguous effect on disparities in healthcare use. We propose a series of projects to study the changes in health care utilization and health that occur as individuals reach the age of Medicare eligibility, and analyze the effects of these changes on the extent of racial and ethnic disparities in health utilization and health. Specifically, we propose to: 1. Analyze the changes in rates of inpatient admissions and outpatient procedures occurring at age 65 for Hispanics, blacks, and whites across major health conditions, and document how the relative changes across groups vary with the nature of the condition and with the characteristics of patients, providers, and institutions. 2. Estimate whether the intensity of hospital treatment varies with eligibility for Medicare, whether these differences affect mortality, and whether the changes in intensity of treatment are different for different ethnic/racial groups. 3. Use panel data sets to estimate the impacts of reaching age 65 on alternative measures of health, physical functioning, and quality of life for Hispanics, blacks and whites. 4. Examine differences across groups in the utilization of health care services in the first few years of Medicare coverage, and test alternative explanations for these differences, including the role of supplemental insurance coverage.

描述（由申请人提供）：Medicare计划几乎为老年人提供了通用的健康保险范围。 Medicare资格的发作与群体间差异下降有关，可以使用门诊护理和住院率上升。但是，令人惊讶的是，非洲裔美国人的增长比白人在65岁时的住院率和包括髋关节和膝盖替代品（包括髋关节和膝盖替代者）的率要小得多。因此，Medicare似乎对医疗保健使用差异有歧义。我们提出了一系列项目，以研究个人达到Medicare资格时的医疗保健利用和健康的变化，并分析这些变化对种族和种族差异在健康利用和健康方面的影响。具体而言，我们提出：1。分析在65岁时，在主要健康状况的西班牙裔，黑人和白人时进行住院入院率和门诊手术的发生率的变化，并记录各组的相对变化如何随着病情的性质以及患者，提供者和机构的特征而变化。 2。估计，医院治疗的强度是否随着医疗保险的资格而变化，这些差异是否影响死亡率，以及不同种族/种族群体的治疗强度的变化是否有所不同。 3。使用面板数据集估算65岁年龄段对西班牙裔，黑人和白人的健康，身体机能和生活质量的替代措施的影响。 4.检查Medicare覆盖范围的最初几年利用医疗服务中各组的差异，并测试这些差异的替代解释，包括补充保险的作用。