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Cohen-Mekelburg S, Jordan A, Kenney B, Burgess HJ, Chang JW, Hu HM, Tapper E, Langa KM, Levine DA, Waljee AK. Loneliness and Depressive Symptoms Are High Among Older Adults With Digestive Disease and Associated With Lower Perceived Health. Clin Gastroenterol Hepatol 2024; 22:621-629.e2. [PMID: 37689253 DOI: 10.1016/j.cgh.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/09/2023] [Accepted: 08/15/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND & AIMS Current approaches to managing digestive disease in older adults fail to consider the psychosocial factors contributing to a person's health. We aimed to compare the frequency of loneliness, depression, and social isolation in older adults with and without a digestive disease and to quantify their association with poor health. METHODS We conducted an analysis of Health and Retirement Study data from 2008 to 2016, a nationally representative panel study of participants 50 years and older and their spouses. Bivariate analyses examined differences in loneliness, depression, and social isolation among patients with and without a digestive disease. We also examined the relationship between these factors and health. RESULTS We identified 3979 (56.0%) respondents with and 3131 (44.0%) without a digestive disease. Overall, 60.4% and 55.6% of respondents with and without a digestive disease reported loneliness (P < .001), 12.7% and 7.5% reported severe depression (P < .001), and 8.9% and 8.7% reported social isolation (P = NS), respectively. After adjusting for covariates, those with a digestive disease were more likely to report poor or fair health than those without a digestive disease (odds ratio [OR], 1.25; 95% CI, 1.11-1.41). Among patients with a digestive disease, loneliness (OR, 1.43; 95% CI, 1.22-1.69) and moderate and severe depression (OR, 2.93; 95% CI, 2.48-3.47; and OR, 8.96; 95% CI, 6.91-11.63, respectively) were associated with greater odds of poor or fair health. CONCLUSIONS Older adults with a digestive disease were more likely than those without a digestive disease to endorse loneliness and moderate to severe depression and these conditions are associated with poor or fair health. Gastroenterologists should feel empowered to screen patients for depression and loneliness symptoms and establish care pathways for mental health treatment.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan; Veterans Affairs Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
| | - Ariel Jordan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Brooke Kenney
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Helen J Burgess
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Joy W Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Hsou Mei Hu
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elliot Tapper
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Kenneth M Langa
- Division of General Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Deborah A Levine
- Division of General Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Akbar K Waljee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan; Veterans Affairs Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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2
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Smith JB, Jayanth P, Hong SA, Simpson MC, Massa ST. The "Medicare effect" on head and neck cancer diagnosis and survival. Head Neck 2023. [PMID: 37096786 DOI: 10.1002/hed.27379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Uninsured individuals age 55-64 experience disproportionately poor outcomes compared to their insured counterparts. Adequate coverage may prevent these delays. This study investigates a "Medicare-effect" on head and neck squamous cell carcinoma (HNSCC) diagnosis and treatment. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried for persons ages 60-70 years in the United States from 2000 to 2016 with HNSCC. A "Medicare effect" was defined as an increase in incidence, reduction in advanced stage presentation, and/or decrease in cancer-specific mortality (CSM). RESULTS Compared to their Medicaid or uninsured counterparts, patients age 65 have an increased incidence of HNSCC diagnosis, reduction in advanced stage presentation, decrease in cancer-specific mortality, and higher likelihood of receiving cancer-specific surgery. CONCLUSIONS Patients age 65 with Medicare have decreased incidence of HNSCC, less hazard of late-stage diagnosis, and lower cancer-specific mortality than their Medicaid or uninsured counterparts, supporting the idea of a "Medicare effect" in HNSCC.
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Affiliation(s)
- Joshua B Smith
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Prerana Jayanth
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Scott A Hong
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Matthew C Simpson
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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3
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Xiao L, Wu Y, Cao X. The health of the elderly and social security in the context of digital financial inclusion in China. Front Public Health 2023; 10:1079436. [PMID: 36699925 PMCID: PMC9868769 DOI: 10.3389/fpubh.2022.1079436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Lei Xiao
- School of Economics and Management, Kunming University, Kunming, Yunnan, China,*Correspondence: Lei Xiao ✉
| | - Yanyan Wu
- School of Economics and Management, Kunming University, Kunming, Yunnan, China
| | - Xin Cao
- Pan-Asia Business School, Yunnan Normal University, Kunming, Yunnan, China
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4
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Zhang Y, Sun Y, Xie M, Chen Y, Cao S. Health shocks, basic medical insurance and common prosperity: Based on the analysis of rural middle-aged and elderly groups. Front Public Health 2022; 10:1014351. [PMID: 36568784 PMCID: PMC9780270 DOI: 10.3389/fpubh.2022.1014351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Health is a major part of human welfare. The index system of common prosperity was constructed for middle-aged and elderly people in rural areas. Besides, the impart of health shocks and rural basic medical insurance on common prosperity was explored. The data for this study came from China Health and Retirement Longitudinal Survey (CHARLS) in 2013, 2015, and 2018. The finding shows that health shocks hindered the improvement of the common prosperity of the middle-aged and elderly in rural areas, among which daily activities produced the greatest negative effect. The heterogeneity analysis shows that health shocks have a stronger negative effect on the common prosperity of low-income groups than that of high-income ones. The shock of daily activity ability has the greatest influence on the middle-aged and elderly between 45 and 55 years old. However, acute health shocks have a strong negative effect on those aged above 56. The mechanism analysis shows that rural basic medical insurance can alleviate the health shocks to middle-aged and elderly people, but the effect is limited. In general, low-income groups benefit more. Therefore, China should speed up the promotion of the Healthy China Strategy and the reform of the rural basic medical insurance system, and prompt changes from an inclusive to a targeted policy to provide more precise safeguards for vulnerable groups.
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Affiliation(s)
- Yuan Zhang
- School of Business Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Yuquan Sun
- Food, Agriculture and Resource Economics, University of Guelph, Guelph, ON, Canada
| | - Mingli Xie
- School of Business Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Yuping Chen
- School of Business Administration, Zhongnan University of Economics and Law, Wuhan, China,*Correspondence: Yuping Chen
| | - Shouhui Cao
- School of Business Administration, Zhongnan University of Economics and Law, Wuhan, China,Shouhui Cao
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5
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Bishop CE. Old & Sick in America: The Journey through the Health Care System. J Aging Soc Policy 2022. [DOI: 10.1080/08959420.2022.2082229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christine E. Bishop
- Atran Foundation Professor of Economics, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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6
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Wu W, Li C, Gao B. Heterogeneity of the Impact of the Social Old-Age Insurance and the Medical Insurance on the Mortality Risk of the Elderly. Front Public Health 2022; 10:807384. [PMID: 35309207 PMCID: PMC8930924 DOI: 10.3389/fpubh.2022.807384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
Based on the frailty Cox model, this paper analyzes CLHLS data from 2008 to 2017/2018 to examine the impact of the social old-age insurance and the medical insurance on the mortality risk of the elderly based on the age structures, urban/rural areas and regions. The results reveal the heterogeneous impact as follows. In terms of the age structures, the social old-age insurance significantly reduces the mortality risk of the elderly aged below 80, but has no significant impact on the elderly aged 80 and above, whereas the medical insurance significantly reduces the mortality risk of the elderly aged 80 and above, but has no significant impact on the elderly aged below 80. In urban/rural areas and different regions, the social old-age insurance has no significant impact on the mortality risk of the elderly, whereas the social medical insurance significantly increases the mortality risk of the elderly in urban areas and the East, and reduces that of the elderly in rural areas and the Middle and the West. When implementing the insurances, China should pay attention to the different attributes of the elderly to guarantee the service quality, including the age structures, urban/rural areas and regions. A full consideration should be given to the allocation of investment and social security resources, so as to address the issue of the mismatch between the supply and demand of medical resources, and finally achieve the success of healthy aging and health equity.
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Affiliation(s)
- Wangchun Wu
- School of Finance, Nankai University, Tianjin, China
| | - Chunhua Li
- School of Economics, Guangxi University for Nationalities, Nanning, China
- *Correspondence: Chunhua Li
| | - Bin Gao
- School of Economics, Guangxi University for Nationalities, Nanning, China
- Bin Gao
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7
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Tipirneni R, Levy HG, Langa KM, McCammon RJ, Zivin K, Luster J, Karmakar M, Ayanian JZ. Changes in Health Care Access and Utilization for Low-SES Adults Aged 51-64 Years After Medicaid Expansion. J Gerontol B Psychol Sci Soc Sci 2021; 76:1218-1230. [PMID: 32777052 DOI: 10.1093/geronb/gbaa123] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Whether the Affordable Care Act (ACA) insurance expansions improved access to care and health for adults aged 51-64 years has not been closely examined. This study examined longitudinal changes in access, utilization, and health for low-socioeconomic status adults aged 51-64 years before and after the ACA Medicaid expansion. METHODS Longitudinal difference-in-differences (DID) study before (2010-2014) and after (2016) Medicaid expansion, including N = 2,088 noninstitutionalized low-education adults aged 51-64 years (n = 633 in Medicaid expansion states, n = 1,455 in nonexpansion states) from the nationally representative biennial Health and Retirement Study. Outcomes included coverage (any, Medicaid, and private), access (usual source of care, difficulty finding a physician, foregone care, cost-related medication nonadherence, and out-of-pocket costs), utilization (outpatient visit and hospitalization), and health status. RESULTS Low-education adults aged 51-64 years had increased rates of Medicaid coverage (+10.6 percentage points [pp] in expansion states, +3.2 pp in nonexpansion states, DID +7.4 pp, p = .001) and increased likelihood of hospitalizations (+9.2 pp in expansion states, -1.1 pp in nonexpansion states, DID +10.4 pp, p = .003) in Medicaid expansion compared with nonexpansion states after 2014. Those in expansion states also had a smaller increase in limitations in paid work/housework over time, compared to those in nonexpansion states (+3.6 pp in expansion states, +11.0 pp in nonexpansion states, DID -7.5 pp, p = .006). There were no other significant differences in access, utilization, or health trends between expansion and nonexpansion states. DISCUSSION After Medicaid expansion, low-education status adults aged 51-64 years were more likely to be hospitalized, suggesting poor baseline access to chronic disease management and pent-up demand for hospital services.
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Affiliation(s)
- Renuka Tipirneni
- Department of Internal Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Helen G Levy
- Institute for Social Research, University of Michigan, Ann Arbor.,Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor.,Institute for Social Research, University of Michigan, Ann Arbor
| | - Ryan J McCammon
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Kara Zivin
- VA Center for Clinical Management Research, University of Michigan, Ann Arbor.,Department of Psychiatry, University of Michigan, Ann Arbor
| | - Jamie Luster
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Monita Karmakar
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - John Z Ayanian
- Department of Internal Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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8
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Xu BC, Li XJ, Gao MY. Influence of Commercial Insurance Purchase on the Health Status of Chinese Residents. Front Public Health 2021; 9:752530. [PMID: 34604168 PMCID: PMC8481586 DOI: 10.3389/fpubh.2021.752530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Under the context of rapid economic and social development, and growing demands for a better life, Chinese residents have been increasingly concerned with their health status and issues. In this study, the internal relations between the purchase of commercial insurance by residents and their health status are analyzed and studied with a polytomous logit model based on the data of Chinese General Social Survey (CGSS) in 2015. According to the research result, purchase of commercial insurance significantly improved the health status of residents, with an improving effect for rural residents apparently better than that among urban residents. In addition, purchase of commercial insurance can promote the health status of residents by increasing their household income. This research will provide an effective reference for the innovative development and medical reform of the commercial insurance of China in the future, which is theoretically and practically significant to the implementation of the Healthy China Strategy.
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Affiliation(s)
- Bao-Chang Xu
- School of Economics, Qingdao University, Qingdao, China
| | - Xiu-Juan Li
- School of Economics, Qingdao University, Qingdao, China
| | - Meng-Yao Gao
- School of Economics, Qingdao University, Qingdao, China
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9
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The contribution of Urban and Rural Resident Basic Medical Insurance to income-related inequality in depression among middle-aged and older adults: Evidence from China. J Affect Disord 2021; 293:168-175. [PMID: 34198032 DOI: 10.1016/j.jad.2021.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Previous studies have not investigated the contribution of medical insurance to income-related inequality in depressive symptoms. To fulfill this research gap, this study aimed to assess the contribution of Urban and Rural Resident Basic Medical Insurance (URRBMI) to income-related inequality in depressive symptoms among middle-aged and older adults in China. METHODS The data of this study was obtained from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). The data of Particulate Matter 2.5 (PM2.5) concentrations were sourced from Atmospheric Composition Analysis Group. Furthermore, concentration curve and concentration index were employed to measure the extent of income-related inequality in depressive symptoms. Moreover, decomposition method of concentration index was used to quantify the contribution of URRBMI to the income-related inequality in depressive symptoms. RESULTS The concentration index values of depression occurrence and score were -0.1067 and -0.0712, respectively, indicating pro-rich inequality. The decomposition results reveal that the contribution rate of URRBMI to concentration index of depression occurrence was 18.88%, which indicates that it reduced the pro-rich inequality in depression occurrence. In addition, the contribution rate of URRBMI to concentration index of depression score was 3.55%, indicating that it relieved the pro-rich inequality in depression score. CONCLUSION This study found pro-rich inequalities in depression occurrence and score which were reduced with the coverage of URRBMI. It is quite necessary to further expand the coverage of URRBMI.
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10
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Yue D, Ponce NA, Needleman J, Ettner SL. The relationship between educational attainment and hospitalizations among middle-aged and older adults in the United States. SSM Popul Health 2021; 15:100918. [PMID: 34568538 PMCID: PMC8449049 DOI: 10.1016/j.ssmph.2021.100918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There has been little research on the relationship between education and healthcare utilization, especially for racial/ethnic minorities. This study aimed to examine the association between education and hospitalizations, investigate the mechanisms, and disaggregate the relationship by gender, race/ethnicity, and age groups. METHODS A retrospective cohort analysis was conducted using data from the 1992-2016 US Health and Retirement Study. The analytic sample consists of 35,451 respondents with 215,724 person-year observations. We employed a linear probability model with standard errors clustered at the respondent level and accounted for attrition bias using an inverse probability weighting approach. RESULTS On average, compared to having an education less than high school, having a college degree or above was significantly associated with an 8.37 pp (95% CI, -9.79 pp to -7.95 pp) lower probability of being hospitalized, and having education of high school or some college was related to 3.35 pp (95% CI, -4.57 pp to -2.14 pp) lower probability. The association slightly attenuated after controlling for income but dramatically reduced once holding health conditions constant. Specifically, given the same health status and childhood environment conditions, compared to those with less than high school degree, college graduates saw a 1.79 pp (95% CI, -3.16 pp to -0.42 pp) lower chance of being hospitalized, but the association for high school graduates became indistinguishable from zero. Additionally, the association was larger for females, whites, and those younger than 78. The association was statistically significantly smaller for black college graduates than their white counterparts, even when health status is held constant. CONCLUSIONS Educational attainment is a strong predictor of hospitalizations for middle-aged and older US adults. Health mediates most of the education-hospitalization gradients. The heterogeneous results across age, gender, race, and ethnicity groups should inform further research on health disparities.
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Affiliation(s)
- Dahai Yue
- Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD, 20742, USA
| | - Ninez A. Ponce
- Department of Health Policy and Management, University of California, Los Angeles, USA
| | - Jack Needleman
- Department of Health Policy and Management, University of California, Los Angeles, USA
| | - Susan L. Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
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11
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Hu F, Shi X, Wang H, Nan N, Wang K, Wei S, Li Z, Jiang S, Hu H, Zhao S. Is Health Contagious?-Based on Empirical Evidence From China Family Panel Studies' Data. Front Public Health 2021; 9:691746. [PMID: 34277551 PMCID: PMC8283520 DOI: 10.3389/fpubh.2021.691746] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
This study empirically analysed the contagion of health using data from China Family Panel Studies. We first controlled variables related to health behaviour, medical conditions, individual characteristics, household characteristics, group characteristics, and prefecture/county characteristics and then employed multiple methods for estimation. The estimates showed that the average health level of others in the community had a significant positive effect on individual self-rated health-health was contagious. The measurement results remained robust after the endogeneity of the core explanatory variables was controlled using two-stage least squares. Furthermore, by analysing the heterogeneity of health contagion, we found that the contagion effect of health varied with the level of medical care, household affiliation, gender, rural/urban areas, and age groups. The contagion effect of health was more pronounced in the elderly population and the rural areas of the central region, where the level of medical care is relatively low, whereas it did not differ significantly between genders. Finally, the learning or imitation mechanism and social interaction mechanism of health contagion were examined.
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Affiliation(s)
- Feng Hu
- Global Value Chain Research Center, Zhejiang Gongshang University, Hangzhou, China
| | - Xiaojiao Shi
- Global Value Chain Research Center, Zhejiang Gongshang University, Hangzhou, China
| | - Haiyan Wang
- School of Economics, East China Normal University, Shanghai, China
| | - Nan Nan
- School of Economics and Management, Shihezi University, Shihezi, China
| | - Kui Wang
- School of Economics, Huazhong University of Science and Technology, Wuhan, China
| | - Shaobin Wei
- International Business Research Institute, Zhejiang Gongshang University, Hangzhou, China
| | - Zhao Li
- School of Master of Business Administration, Zhejiang Gongshang University, Hangzhou, China
| | - Shanshan Jiang
- International Business Research Institute, Zhejiang Gongshang University, Hangzhou, China
| | - Hao Hu
- School of Economics, Shanghai University, Shanghai, China
| | - Shuang Zhao
- International Business Research Institute, Zhejiang Gongshang University, Hangzhou, China
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12
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Patel DC, He H, Berry MF, Yang CFJ, Trope WL, Wang Y, Lui NS, Liou DZ, Backhus LM, Shrager JB. Cancer diagnoses and survival rise as 65-year-olds become Medicare-eligible. Cancer 2021; 127:2302-2310. [PMID: 33778953 DOI: 10.1002/cncr.33498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/06/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A Medicare effect has been described to account for increased health care utilization occurring at the age of 65 years. The existence of such an effect in cancer care, where it would be most likely to reduce mortality, has been unclear. METHODS Patients aged 61 to 69 years who were diagnosed with lung, breast, colon, or prostate cancer from 2004 to 2016 were identified with the Surveillance, Epidemiology, and End Results database and were dichotomized on the basis of eligibility for Medicare (61-64 vs 65-69 years). With age-over-age (AoA) percent change calculations, trends in cancer diagnoses and staging were characterized. After matching, uninsured patients who were 61 to 64 years old (pre-Medicare group) were compared with insured patients who were 65 to 69 years old (post-Medicare group) with respect to cancer-specific mortality. RESULTS In all, 134,991 patients were identified with lung cancer, 175,558 were identified with breast cancer, 62,721 were identified with colon cancer, and 238,823 were identified with prostate cancer. The AoA growth in the number of cancer diagnoses was highest at the age of 65 years in comparison with all other ages within the decade for all 4 cancers (P < .01, P < .001, P < .01, and P < .001, respectively). In a comparison of diagnoses at the age of 65 years with those in the 61- to 64-year-old cohort, the greatest difference for all 4 cancers was seen in stage I. In matched analyses, the 5-year cancer-specific mortality was worse for lung (86.3% vs 78.5%; P < .001), breast (32.7% vs 11.0%; P < .001), colon (57.1% vs 35.6%; P < .001), and prostate cancer (16.9% vs 4.8%; P < .001) in the uninsured pre-Medicare group than the insured post-Medicare group. CONCLUSIONS The age threshold of 65 years for Medicare eligibility is associated with more cancer diagnoses (particularly stage I), and this results in lower long-term cancer-specific mortality for all cancers studied. LAY SUMMARY Contributing to the current debate regarding Medicare for all, this study shows that the expansion of Medicare would improve cancer outcomes for the near elderly.
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Affiliation(s)
- Deven C Patel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Hao He
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Winston L Trope
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Yoyo Wang
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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13
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Yeung K, Dorsey CN, Mettert K. Effect of new Medicare enrollment on health, healthcare utilization, and cost: A scoping review. J Am Geriatr Soc 2021; 69:2335-2343. [PMID: 33721340 DOI: 10.1111/jgs.17113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/28/2021] [Accepted: 02/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND More than three million Americans turn 65 each year and newly enroll in Medicare, making this one of the most common insurance transitions. Non-Medicare insurance transitions are associated with changes in health, healthcare utilization and costs. In addition, older Americans have higher morbidity, mortality, healthcare utilization, and healthcare costs than the general population. However, the effect of new Medicare enrollment on these outcomes is unclear. DESIGN We conducted a scoping review to rigorously identify the scope of evidence on the association between new Medicare enrollment and health, healthcare utilization and costs. SETTING We included English-language, peer-reviewed, studies cataloged in Medline (PubMed) and EconLit from 1998 to 2018. PARTICIPANTS Individuals newly enrolling in Medicare. MEASUREMENTS We measured health (e.g., self-reported health), healthcare utilization (e.g., provider visits, preventive care, and hospitalizations) and costs (e.g., patient out-of-pocket and health plan spending). RESULTS We screened 5265 articles and included 20 articles. New Medicare enrollment was found to increase self-reported health and healthcare utilization overall, as well as reduce disparities across racial and socioeconomic strata. Provider visits, preventive care and hospitalizations all increased. However, patient out-of-pocket spending decreased, and health plan spending also decreased, when Medicare's lower prices were accounted for. Few studies compared outcomes among new Medicare Advantage enrollees with new Medicare fee-for-service enrollees. None of the studies specifically evaluated the effect of new Medicare enrollment on adults with multiple chronic conditions. CONCLUSION New Medicare enrollment improves access overall and reduces access disparities. However, the impact of new Medicare enrollment among subgroups defined by insurance coverage type and number of chronic conditions is less clear. Future work should also evaluate the mechanism for increases in hospitalizations.
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Affiliation(s)
- Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.,The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA.,Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Kayne Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Song L, Wang Y, Chen B, Yang T, Zhang W, Wang Y. The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1525. [PMID: 32120888 PMCID: PMC7084505 DOI: 10.3390/ijerph17051525] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to evaluate the association of insurance status with all-cause and cause-specific mortality. A total of 390,881 participants, aged 18-64 years and interviewed from 1997 to 2013 were eligible for a mortality follow-up in December 31, 2015. Cox proportional hazards models were used to calculate the hazards ratios (HR) and 95% confidence intervals (CI) to determine the association between insurance status and all-cause and cause-specific mortality. The sample group cumulatively aged 4.22 million years before their follow-ups, with a mean follow-up of 10.4 years, and a total of 22,852 all-cause deaths. In fully adjusted models, private insurance was significantly associated with a 17% decreased risk of mortality (HR = 0.83; 95% CI = 0.80-0.87), but public insurance was associated with a 21% increased risk of mortality (HR = 1.21; 95% CI = 1.15-1.27). Compared to noninsurance, private coverage was associated with about 21% lower CVD mortality risk (HR = 0.79, 95% CI = 0.70-0.89). In addition, public insurance was associated with increased mortality risk of kidney disease, diabetes and CLRD, compared with noninsurance, respectively. This study supports the current evidence for the relationship between private insurance and decreased mortality risk. In addition, our results show that public insurance is associated with an increased risk of mortality.
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Affiliation(s)
- Liying Song
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Yan Wang
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China;
- Mianyang Taxation Bureau of Sichuan Province, State Taxation Administration, Mianyang 621000, China
| | - Baodong Chen
- Department of Accounting, School of Management, Xi’an Polytechnic University, No.19, Jinhua South Road, Xincheng District, Xi’an 710048, China;
| | - Tan Yang
- School of Finance and Accounting, Xi’an University of Technology, No. 58, Yanxiang Road, Yanta District, Xi’an 710054, China;
| | - Weiliang Zhang
- School of Economics and Finance, Xi’an International Studies University, South Wenyuan Road, Chang’an District, Xi’an 710128, China;
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China
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15
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Myerson RM, Tucker-Seeley RD, Goldman DP, Lakdawalla DN. Does Medicare Coverage Improve Cancer Detection and Mortality Outcomes? JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2020; 39:577-604. [PMID: 32612319 PMCID: PMC7318119 DOI: 10.1002/pam.22199] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Medicare is a large government health insurance program in the United States that covers about 60 million people. This paper analyzes the effects of Medicare insurance on health for a group of people in urgent need of medical care: people with cancer. We used a regression discontinuity design to assess impacts of near-universal Medicare insurance at age 65 on cancer detection and outcomes, using population-based cancer registries and vital statistics data. Our analysis focused on the three tumor sites for which screening is recommended both before and after age 65: breast, colorectal, and lung cancer. At age 65, cancer detection increased by 72 per 100,000 population among women and 33 per 100,000 population among men; cancer mortality also decreased by nine per 100,000 population for women but did not significantly change for men. In a placebo check, we found no comparable changes at age 65 in Canada. This study provides the first evidence to our knowledge that near-universal access to Medicare at age 65 is associated with improvements in population-level cancer mortality.
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Glied S, Hong K. Health care in a multi-payer system: Spillovers of health care service demand among adults under 65 on utilization and outcomes in medicare. JOURNAL OF HEALTH ECONOMICS 2018; 60:165-176. [PMID: 29990674 DOI: 10.1016/j.jhealeco.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/01/2018] [Accepted: 05/05/2018] [Indexed: 06/08/2023]
Abstract
This paper examines, theoretically and empirically, how changes in the demand for health insurance and medical services in the non-Medicare population - coverage eligibility changes for parents and the firm size composition of employment - spill over and affect health insurance coverage and how these factors affect per beneficiary Medicare spending. We find that factors that increase coverage and hence demand for medical services in the non-Medicare population generate contemporaneous decreases in per beneficiary Medicare spending and utilization, particularly for high variation services. Moreover, these increases in the demand for medical services in the non-Medicare population are not associated with increases in the total quantity of physician services supplied. Finally, we find that the higher Medicare spending associated with lower insurance coverage rates in the non-Medicare population does not generate improvements in measures of Medicare patients' well-being, such as patient experience of care, ambulatory-care sensitive admissions, and mortality.
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Affiliation(s)
- Sherry Glied
- Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette St., 2nd floor, New York, NY 10012, United States.
| | - Kai Hong
- Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette St., 2nd floor, New York, NY 10012, United States.
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17
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Stecker EC, Reinier K, Rusinaru C, Uy-Evanado A, Jui J, Chugh SS. Health Insurance Expansion and Incidence of Out-of-Hospital Cardiac Arrest: A Pilot Study in a US Metropolitan Community. J Am Heart Assoc 2017; 6:JAHA.117.005667. [PMID: 28659263 PMCID: PMC5586291 DOI: 10.1161/jaha.117.005667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health insurance has many benefits including improved financial security, greater access to preventive care, and better self-perceived health. However, the influence of health insurance on major health outcomes is unclear. Sudden cardiac arrest prevention represents one of the major potential benefits from health insurance, given the large impact of sudden cardiac arrest on premature death and its potential sensitivity to preventive care. METHODS AND RESULTS We conducted a pre-post study with control group examining out-of-hospital cardiac arrest (OHCA) among adult residents of Multnomah County, Oregon (2015 adult population 636 000). Two time periods surrounding implementation of the Affordable Care Act were evaluated: 2011-2012 ("pre-expansion") and 2014-2015 ("postexpansion"). The change in OHCA incidence for the middle-aged population (45-64 years old) exposed to insurance expansion was compared with the elderly population (age ≥65 years old) with constant near-universal coverage. Rates of OHCA among middle-aged individuals decreased from 102 per 100 000 (95% CI: 92-113 per 100 000) to 85 per 100 000 (95% CI: 76-94 per 100 000), P value 0.01. The elderly population experienced no change in OHCA incidence, with rates of 275 per 100 000 (95% CI: 250-300 per 100 000) and 269 per 100 000 (95% CI: 245-292 per 100 000), P value 0.70. CONCLUSIONS Health insurance expansion was associated with a significant reduction in OHCA incidence. Based on this pilot study, further investigation in larger populations is warranted and feasible.
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Affiliation(s)
- Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | | | - Carmen Rusinaru
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Jon Jui
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Sumeet S Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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18
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Castaneda MA, Saygili M. The health conditions and the health care consumption of the uninsured. HEALTH ECONOMICS REVIEW 2016; 6:55. [PMID: 27924584 PMCID: PMC5142170 DOI: 10.1186/s13561-016-0137-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/30/2016] [Indexed: 06/06/2023]
Abstract
This paper investigates the difference in the health conditions and the health care consumption of uninsured individuals as compared to individuals with private insurance, using a nationally representative data set of inpatient hospital admissions from the US. In line with the previous literature, our results indicate that uninsured individuals are, on average, in worse health conditions. However, if we compare individuals within the same diagnosis category, the uninsured are actually healthier, with a lower number of chronic conditions and a lower risk of mortality. This indicates that the uninsured are admitted to the hospital only for more serious conditions. In addition, our results show that uninsured individuals consume less health care. In particular, conditional on being admitted to a hospital and controlling for health conditions, the uninsured have lower total charges, fewer procedures, and a higher mortality rate.
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Affiliation(s)
- Marco A. Castaneda
- Department of Social Sciences, The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799 USA
| | - Meryem Saygili
- Department of Social Sciences, The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799 USA
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WU Y, HUANG Y, LU J. Potential Effect of Medical Insurance on Medicare: Evidence from China. IRANIAN JOURNAL OF PUBLIC HEALTH 2016; 45:1247-1260. [PMID: 27957431 PMCID: PMC5149488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the increased range of medical insurance coverage in China, the proportion of medical expenditure shouldered by individuals is declining. The problem is the rapidly growing scale of medical expenditures challenges the sustainability of medical insurance funds. METHODS This study used the Heckman selection model, survival analysis, and ordered probit model to evaluate the effect of medical insurance on the expenditures in outpatient and inpatient health care, survival time, and improvement of self-rated health of test subjects, respectively. RESULTS Medical insurance exerts a differential effect on the expenditures in outpatient and inpatient health care. On average, the expenditures in outpatient and inpatient health care of test subjects participating in premium health insurance plans increased by 38.6% and 72.6%, respectively. Participation in medical insurance plans exhibits no significant correlation with the survival time of test subjects, but their self-rated health shows a significant correlation (P < 0.01). CONCLUSION Although medical insurance does not significantly reduce mortality or prolong the survival time of test subjects, it improves their health status. This study suggests that the Chinese government should eliminate deductible medical insurance payments and utilize medical resources on minor ailment treatment and disease prevention to improve the health status of people.
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Affiliation(s)
- Yongqiu WU
- College of Economics and Business Administration, Chongqing University, Chongqing, China,Corresponding Author:
| | - Yi HUANG
- College of Economics and Business Administration, Chongqing University, Chongqing, China
| | - Jintao LU
- School of Management, Northwestern Polytechnical University, Xi’an, China
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20
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Huesch MD, Ong MK. Lung Cancer Care Before and After Medicare Eligibility. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 53:53/0/0046958016647301. [PMID: 27166413 PMCID: PMC5798706 DOI: 10.1177/0046958016647301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/31/2016] [Indexed: 11/16/2022]
Abstract
Uninsured and underinsured near-elderly may not have timely investigation, diagnosis, or care of cancer. Prior studies suggest Medicare eligibility confers significant and substantial reductions in mortality and increases in health service utilization. We compared 2245 patients diagnosed with lung cancer at ages 64.5 to 65 years and 2512 patients aged 65 to 65.5 years, with 2492 patients aged 65.5 to 66 years (controls) in 2000 to 2005. Compared with controls, patients diagnosed with lung cancer before Medicare eligibility had no statistically significant differences in cancer stage, time to treatment, type of treatment, and survival. Study power was sufficient to exclude mortality reductions and health service utilization changes of the magnitude found in prior work, suggesting that typically, appropriate lung cancer care may be sought and delivered regardless of insurance status.
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Affiliation(s)
| | - Michael K Ong
- University of California, Los Angeles, USA University of California, Los Angeles, USA
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21
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Dillender M, Mulligan K. The Effect of Medicare Eligibility on Spousal Insurance Coverage. HEALTH ECONOMICS 2016; 25:591-605. [PMID: 25762207 DOI: 10.1002/hec.3175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 12/15/2014] [Accepted: 02/13/2015] [Indexed: 06/04/2023]
Abstract
A majority of married couples in the USA take advantage of the fact that employers often provide health insurance coverage to spouses. When older spouses become eligible for Medicare, however, many of them can no longer provide their younger spouses with coverage. In this paper, we study how spousal eligibility for Medicare affects the health insurance and health care access of younger spouses. We find that spousal eligibility for Medicare results in younger spouses no longer having employers pay for their insurance and being less likely to have employer-sponsored coverage. Instead, younger spouses switch to privately purchased coverage, which tends to be worse than what they had before their spouses became eligible for Medicare. We also find suggestive evidence that younger spouses are less likely to use health care services after their older spouses become eligible for Medicare.
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Affiliation(s)
- Marcus Dillender
- W.E. Upjohn Institute for Employment Research, Kalamazoo, MI, USA
| | - Karen Mulligan
- Department of Economics and Finance, Middle Tennessee State University, Murfreesboro, TN, USA
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22
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The Influence of Social Welfare Policies on Health Disparities Across the Life Course. HANDBOOKS OF SOCIOLOGY AND SOCIAL RESEARCH 2016. [DOI: 10.1007/978-3-319-20880-0_29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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23
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Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea. Soc Sci Med 2015; 138:241-7. [PMID: 26123883 DOI: 10.1016/j.socscimed.2015.06.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To increase financial protection for catastrophic illness, South Korean government expanded the National Health Insurance (NHI) benefit coverage for cancer patients in September 2005. This paper investigated whether the policy has reduced inequality in catastrophic payments, defined as annual out-of-pocket (OOP) health payments exceeding 10% annual income, across different income groups. This study used the NHI claims data from 2002 to 2004 and 2006 to 2010. Triple difference estimator was employed to compare cancer patients as a treatment group with those with liver and cardio-cerebrovascular diseases as control groups and the low-income with the high-income groups. While catastrophic payments decreased in cancer patients compared with those of two diseases, they appeared to decrease more in the high-income than the low-income group. Considering that increased health care utilization and poor economic capacity may lead to a smaller reduction in catastrophic payments for the low-income than the high-income patients, the government needs to consider additional policy measures to increase financial protection for the poor.
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24
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Coey D. The effect of Medicaid on health care consumption of young adults. HEALTH ECONOMICS 2015; 24:558-565. [PMID: 24577756 DOI: 10.1002/hec.3042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 11/20/2013] [Accepted: 01/20/2014] [Indexed: 06/03/2023]
Abstract
All states provide Medicaid until the age of 19 years. After 19 years, young adults may become ineligible for Medicaid. Using the Medical Expenditure Panel Survey, we find that the resulting loss of Medicaid coverage causes substantial changes to the level and composition of health care use. The total number of visits to health care providers falls by over 60%, two-thirds of which is due to a decline in office visits. Expenditures, in particular inpatient expenditures, also appear to fall sharply.
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Affiliation(s)
- Dominic Coey
- Economics Department, Stanford University, Stanford, CA, USA
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25
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Yin N. Sicker and Poorer: The Consequences of Being Uninsured for People With Disability During the Medicare Waiting Period. Health Serv Res Manag Epidemiol 2015; 2:2333392815571583. [PMID: 28462252 PMCID: PMC5266456 DOI: 10.1177/2333392815571583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Disabled individuals younger than 65 years are entitled to Medicare coverage through the Social Security Disability Insurance (DI) program, but only if they have completed a 2-year waiting period. This is the first study that uses longitudinal panel data, the Health and Retirement Study, and examines whether and to what extent the health and economic status are affected among disability beneficiaries who are uninsured during the Medicare waiting period. METHODS In a quasiexperiment research design, using a difference-in-difference (diff-in-diff) estimator, we compare changes in health and economic outcomes pre-/postentering the DI program for disability beneficiaries with alternative public health insurance and those without. RESULTS The adjusted diff-in-diff estimates suggest that disability beneficiaries who are uninsured during the waiting period, compared to those who are insured, are 13.6 percentage point more likely to report poor health, 6.3 percentage point less likely to be in excellent health, declare more difficulties in activities of daily living, and 30% higher medical expenditures from out of pocket. CONCLUSIONS The findings highlight punitive health and economic effects of the Medicare waiting period for uninsured disability beneficiaries. We also discuss the implications of the findings for the Affordable Care Act reform.
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Affiliation(s)
- Na Yin
- School of Public Affairs, Baruch College, City University of New York Institute for Demographic Research, One Bernard Baruch Way, New York, NY, USA
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26
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Levy H. Assessing the Need for a New Household Panel Study: Health Insurance and Health Care. JOURNAL OF ECONOMIC AND SOCIAL MEASUREMENT 2015; 40:341-356. [PMID: 27279677 DOI: 10.3233/jem-150408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper considers the availability of data for addressing questions related to health insurance and health care and the potential contribution of a new household panel study. The paper begins by outlining some of the major questions related to policy and concludes that survey data on health insurance, access to care, health spending, and overall economic well-being will likely be needed to answer them. The paper considers the strengths and weaknesses of existing sources of survey data for answering these questions. The paper concludes that either a new national panel study, an expansion in the age range of subjects in existing panel studies, or a set of smaller changes to existing panel and cross-sectional surveys, would significantly enhance our understanding of the dynamics of health insurance, access to health care, and economic well-being.
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Affiliation(s)
- Helen Levy
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI 48104,
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Kim S, Kwon S. Has the National Health Insurance improved the inequality in the use of tertiary-care hospitals in Korea? Health Policy 2014; 118:377-85. [DOI: 10.1016/j.healthpol.2014.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
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Kim S, Kwon S. The effect of extension of benefit coverage for cancer patients on health care utilization across different income groups in South Korea. ACTA ACUST UNITED AC 2014; 14:161-77. [DOI: 10.1007/s10754-014-9144-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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Decker SL, Doshi JA, Knaup AE, Polsky D. Health service use among the previously uninsured: is subsidized health insurance enough? HEALTH ECONOMICS 2012; 21:1155-68. [PMID: 22945812 PMCID: PMC3886823 DOI: 10.1002/hec.1780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/25/2011] [Accepted: 06/15/2011] [Indexed: 06/01/2023]
Abstract
Although it has been shown that gaining Medicare coverage at age 65 years increases health service use among the uninsured, difficulty in changing habits or differences in the characteristics of previously uninsured compared with insured individuals may mean that the previously uninsured continue to use the healthcare system differently from others. This study uses Medicare claims data linked to two different surveys--the National Health Interview Survey and the Health and Retirement Study--to describe the relationship between insurance status before age 65 years and the use of Medicare-covered services beginning at age 65 years. Although we do not find statistically significant differences in Medicare expenditures or in the number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 years continue to use the healthcare system differently from those who were privately insured. Specifically, they have 16% fewer visits to office-based physicians but make 18% and 43% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured seem to continue to use the healthcare system differently from the previously insured. This question may be important to consider as health coverage expansions are implemented.
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Affiliation(s)
- Sandra L Decker
- National Center for Health Statistics, Hyattsville, MD 20782, USA.
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David G, Saynisch P, Acevedo-Perez V, Neuman MD. Affording to wait: Medicare initiation and the use of health care. HEALTH ECONOMICS 2012; 21:1030-1036. [PMID: 21805531 DOI: 10.1002/hec.1772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 05/21/2011] [Accepted: 05/24/2011] [Indexed: 05/31/2023]
Abstract
Delays in receipt of necessary diagnostic and therapeutic medical procedures related to the timing of Medicare initiation at age 65 years have potentially broad welfare implications. We use 2005-2007 data from Florida and North Carolina to estimate the effect of initiation of Medicare benefits on healthcare utilization across procedures that differ in urgency and coverage. In particular, we study trends in the use of elective procedures covered by Medicare to treat conditions that vary in symptoms; these are compared with elective surgical procedures not eligible for Medicare reimbursement, and to a set of urgent and emergent procedures. We find large discontinuities in health services utilization at age 65 years concentrated among low-urgency, Medicare-reimbursable procedures, most pronounced among screening interventions and treatments for minimally symptomatic disease.
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Affiliation(s)
- Guy David
- Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
Almost 50 years ago, John F. Kennedy told Yale's graduating class that "what is needed today is a new, difficult but essential confrontation with reality, for the great enemy of truth is very often not the lie-deliberate, contrived and dishonest-but the myth-persistent, persuasive and unrealistic." Today's myth is the belief that 30% of health care spending is due to supplier-induced demand and that this amount could be saved if high-spending regions could more closely resemble low-spending regions. The reality is that, while quality and efficiency remain important goals, the major factors driving geographic differences are related to income inequality. Yet, following the road map of the Dartmouth Atlas, the Affordable Care Act includes penalties for hospitals with excess preventable readmissions (which are mainly of the poor), incentive payments for providers in counties that have the lowest Medicare expenditures (where there tends to be less poverty), incentives for physicians and hospitals that attain new "efficiency standards" (ie, costs similar to the lowest), and a call for the Institute of Medicine to recommend additional incentive strategies based on geographic variation. This scenario iscoupled with a growing bureaucracy, following the blueprint laid out by Brennan and Berwick in the 1990s, but with no tangible measures to increase physician supply. Meaningful health care reform means accepting the reality that poverty and its cultural extensions are the major cause of geographic variation in health care utilization and a major source of escalating health care spending. And it means acknowledging Bertrand Russell's admonition that a high degree of income inequality is not compatible with political democracy, nor is it compatible with health care that this nation can afford. As solutions are sought both within and outside of the health care system, misunderstandings of how and why health care varies geographically cannot be allowed to deter these efforts, and the pervasive impact of poverty cannot be ignored.
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Affiliation(s)
- Richard A Cooper
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA.
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McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Commentary: assessing the health effects of Medicare coverage for previously uninsured adults: a matter of life and death? Health Serv Res 2010; 45:1407-22; discussion 1423-9. [PMID: 20337735 DOI: 10.1111/j.1475-6773.2010.01085.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- J Michael McWilliams
- Department of Health Care Policy, Harvard Medical School, and Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Polsky D, Doshi JA, Manning WG, Paddock S, Cen L, Rogowski J, Escarce JJ. Response to McWilliams Commentary: “Assessing the Health Effects of Medicare Coverage for Previously Uninsured Adults: A Matter of Life and Death?”. Health Serv Res 2010. [DOI: 10.1111/j.1475-6773.2010.01154.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ng JH, Kaftarian SJ, Tilson WM, Gorrell P, Chen X, Chesley FD, Scholle SH. Self-Reported Delays in Receipt of Health Care among Women with Diabetes and Cardiovascular Conditions. Womens Health Issues 2010; 20:316-22. [DOI: 10.1016/j.whi.2010.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 06/08/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
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McWilliams JM. Health consequences of uninsurance among adults in the United States: recent evidence and implications. Milbank Q 2009; 87:443-94. [PMID: 19523125 DOI: 10.1111/j.1468-0009.2009.00564.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Uninsured adults have less access to recommended care, receive poorer quality of care, and experience worse health outcomes than insured adults do. The potential health benefits of expanding insurance coverage for these adults may provide a strong rationale for reform. However, evidence of the adverse health effects of uninsurance has been largely based on observational studies with designs that do not support causal conclusions. Although recent research using more rigorous methods may offer a better understanding of this important subject, it has not been comprehensively reviewed. METHODS The clinical and economic literature since 2002 was systematically searched. New research contributions were reviewed and evaluated based on their methodological strength. Because the effectiveness of medical care varies considerably by clinical risk and across conditions, the consistency of study findings with clinical expectations was considered in their interpretation. Updated conclusions were formulated from the current body of research. FINDINGS The quality of research has improved significantly, as investigators have employed quasi-experimental designs with increasing frequency to address limitations of earlier research. Recent studies have found consistently positive and often significant effects of health insurance coverage on health across a range of outcomes. In particular, significant benefits of coverage have now been robustly demonstrated for adults with acute or chronic conditions for which there are effective treatments. CONCLUSIONS Based on the evidence to date, the health consequences of uninsurance are real, vary in magnitude in a clinically consistent manner, strengthen the argument for universal coverage in the United States, and underscore the importance of evidence-based determinations in providing health care to a diverse population of adults.
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Affiliation(s)
- J Michael McWilliams
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, USA.
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