The Impact of Medicare on Individual Longevity: Evidence from Medicare Introduction Using Big Data

医疗保险对个人寿命的影响：使用大数据引入医疗保险的证据

• 批准号: 10575297
• 负责人: Dahai Yue
• 金额: $ 25.99万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10575297
• 关键词: Affect; Age; Area; Big Data; Birth; Censuses; Characteristics; Chronic; Coronary Artery Bypass; Data; Data Aggregation; Data Set; Death Records; Disabled Persons; Education; Elderly; Eligibility Determination; Ethnic Origin; Evaluation; Gender; Genealogical Tree; Generations; Geographic Locations; Geography; Goals; Health; Health Insurance; Health Policy; Heterogeneity; Hospitalization; Hospitals; Income; Individual; Insurance; Insurance Coverage; Interruption; Investigation; Investments; Knowledge; Life Expectancy; Link; Long-Term Effects; Longevity; Measurable; Measures; Medical; Medicare; Modeling; Mortality Decline; Occupations; Operative Surgical Procedures; Outcome; Participant; Patients; Pattern; Physicians; Policies; Policy Maker; Population; Preventive care; Price; Privatization; Publishing; Race; Records; Reduce health disparities; Religion; Reporting; Research; Running; Series; Services; Socioeconomic Status; Subgroup; Surveys; Time; Time Series Analysis; Variant; Work; age group; cohort; design; geographic difference; health care availability; health care service utilization; human old age (65+); improved; individual variation; mortality; novel; population health; programs; simulation; sociodemographic factors; socioeconomics; trend

PROJECT ABSTRACT Prior studies have reported that the Medicare program does not result in significant declines of mortality rates, except among severely ill patients who require immediate hospitalization and among the disabled. But none of the previous studies has estimated the lifetime effects of having access to the Medicare program—they only investigated its short-term impacts. In other contexts, prior research has found that short-term evaluations can miss important long-term effects. In the case of policies affecting health care access, this issue is particularly important. Because Medicare covers important preventive care and helps participants to manage chronic conditions, the cumulative impact of having access to Medicare might be big, even if its short-term impact is limited. The main goal of this project is to estimate the long-term impact of Medicare on longevity for the population as a whole and various subgroups. Prior work is often limited in its investigation of heterogeneity because it relies on published aggregate mortality rates which are only broken down by geography, gender, race/ethnicity, and age, but not by any other measure of socioeconomic status. Thus, a knowledge gap exists on the lifetime effect of Medicare on individual (completed) longevity and whether this varies across socioeconomic groups. The proposed exploratory project will examine the impact of Medicare’s introduction on the longevity of the affected cohorts. When Medicare took effect in July 1966, it created variations in the age when Medicare’s first-generation recipients gained Medicare coverage: for example, those born in 1902 became eligible at 65 whereas those born in 1891 gained eligibility at age 75. This project will use a large and newly created dataset that links the US census with genealogical data. To our knowledge, this dataset will be the largest dataset to date in the US containing information on both individual longevity as well as individual socioeconomic characteristics. This study will first examine Medicare’s short-term effects on annual mortality rates, reevaluating previous studies but using individual-level data, and extending the results to look at effects among various subgroups (Aim 1). Then, this project will investigate the cumulative long-term effect of Medicare on longevity by comparing the average longevity of individuals who gained Medicare at different ages using an interrupted time-series analysis, for all and by subgroup (Aim 2). Finally, the project will leverage geographic and individual variation in private health insurance before Medicare’s introduction to estimate the causal lifetime effect of Medicare on longevity (Aim 3). A difference-in-differences strategy will be used: we will assess if the changes in longevity for groups who gained Medicare coverage at age 65 or at older ages are greater for those who were already likely to have private health insurance, either because of their geographic location or their personal characteristics. The analysis will be repeated based on occupation, education, income, and other measures of socioeconomic status.

项目摘要 先前的研究报告说，医疗保险计划不会导致死亡率大幅下降， 除了需要立即住院的严重患者和残疾人中。但是没有 先前的研究估计了访问Medicare计划的终生影响 - 它们仅 研究了其短期影响。在其他情况下，先前的研究发现，短期评估可以 错过重要的长期影响。在影响医疗保健访问的政策的情况下，尤其是 重要的。因为Medicare涵盖了重要的预防保健，并帮助参与者管理慢性 条件，访问Medicare的累积影响可能很大，即使其短期影响是 有限的。该项目的主要目标是估计医疗保险对寿命的长期影响 人口全部和各种亚组。先前的工作通常受到异质性投资的限制 因为它依赖于已发布的总死亡率，这些死亡率仅被地理，性别， 种族/种族和年龄，但不是通过任何其他衡量社会经济地位的方法。那是一个知识差距 关于医疗保险对个人（已完成）寿命的寿命效果，以及这是否会随着 社会经济群体。拟议的探索项目将研究Medicare的介绍对 受影响人群的寿命。 1966年7月Medicare生效时，它在年龄上产生了差异 当Medicare的第一代接收者获得Medicare覆盖范围时：例如，那些出生于1902年 符合65岁的资格，而1891年出生的人在75岁时获得资格。该项目将使用大型和 新创建的数据集将美国人口普查与家谱数据联系起来。据我们所知，该数据集将是 迄今为止，在美国迄今为止最大的数据集，其中包含有关个人寿命和个人的信息 社会经济特征。这项研究将首先研究Medicare对年死亡率的短期影响 比率，重新评估以前的研究，但使用个体级别的数据，并扩展结果以查看效果 在各个子组中（AIM 1）。然后，该项目将调查 通过比较在不同年龄段获得Medicare的个人的平均寿命来长寿的Medicare 使用中断的时间序列分析，用于所有子组（AIM 2）。最后，该项目将利用 Medicare介绍之前的私人健康保险的地理和个人差异 Medicare对寿命的因果生命影响（AIM 3）。将使用差异差异策略：我们将 评估在65岁时或年龄较大的群体中的长寿变化是 对于那些可能拥有私人健康保险的人来说，要么是因为他们的地理 位置或其个人特征。分析将根据占领，教育， 收入和其他社会经济地位的措施。