McWilliams J Michael, Zaslavsky Alan M, Meara Ellen, Ayanian John Z
Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass 02115, USA.
JAMA. 2003 Aug 13;290(6):757-64. doi: 10.1001/jama.290.6.757.
Uninsured adults receive less appropriate care and have more adverse health consequences than insured adults. Longitudinal studies would help to more clearly define the effects of health insurance on health care and health.
To assess the differential effects of gaining Medicare coverage on use of basic clinical services and medications by previously insured and uninsured adults.
Household survey data from the nationally representative Health and Retirement Study were used to analyze differences in receipt of basic clinical services by adults in 1996 and 2000, before and after becoming eligible for Medicare at age 65 years.
A total of 2203 adults aged 60 to 64 years in 1996 who were classified as continuously uninsured (n = 167), intermittently uninsured (n = 216), or continuously insured (n = 1820) in 1994 and 1996, prior to Medicare eligibility.
Individuals' reports of receiving cholesterol testing, mammography (in women), prostate examination (in men), and treatment of arthritis and hypertension in the prior 2 years.
The difference in cholesterol testing between continuously insured and continuously uninsured adults was significantly reduced after Medicare eligibility (35.4% vs 17.7%; change of -17.7% [95% CI, -29.3% to -6.2%]; P =.003), and the reduction was substantially greater among those with hypertension or diabetes than among other adults (29.2% vs 7.7%; difference of 21.5% [95% CI, 0.2% to 42.9%]; P =.048). Differences in use were similarly reduced after Medicare eligibility for mammography in women (30.3% vs 15.0%; change of -15.3% [95% CI, -29.9% to -0.7%]; P =.04) and prostate examination in men (45.2% vs 20.0%; change of -25.2% [95% CI, -45.4% to -5.1%]; P =.01). Continuously uninsured adults with arthritis reported significantly greater increases in arthritis-related medical visits and limitations of activity than continuously insured adults after Medicare eligibility, but not greater increases in arthritis treatments. Among adults with hypertension, differences in use of antihypertensive medications between continuously uninsured and insured adults were essentially unchanged after Medicare coverage.
Previously uninsured adults substantially increased their use of covered basic clinical services but not medications after gaining Medicare coverage. An affordable option through which near-elderly uninsured adults could purchase Medicare coverage might have similar effects.
与参保成年人相比，未参保成年人接受的医疗服务不够恰当，健康状况也更差。纵向研究有助于更清晰地界定医疗保险对医疗保健和健康的影响。
评估获得医疗保险覆盖对先前参保和未参保成年人使用基本临床服务和药物的不同影响。
利用具有全国代表性的健康与退休研究中的家庭调查数据，分析1996年和2000年（65岁符合医疗保险资格之前和之后）成年人接受基本临床服务的差异。
1996年共有2203名60至64岁的成年人，他们在1994年和1996年医疗保险资格之前被分类为持续未参保（n = 167）、间断未参保（n = 216）或持续参保（n = 1820）。
个体报告在过去2年中接受胆固醇检测、乳房X光检查（女性）、前列腺检查（男性）以及关节炎和高血压治疗的情况。
符合医疗保险资格后，持续参保和持续未参保成年人之间胆固醇检测的差异显著降低（35.4%对17.7%；变化-17.7%[95%CI，-29.3%至-6.2%]；P =.003），高血压或糖尿病患者的降低幅度明显大于其他成年人（29.2%对7.7%；差异21.5%[95%CI，0.2%至42.9%]；P =.048）。符合医疗保险资格后，女性乳房X光检查（30.3%对15.0%；变化-15.3%[95%CI，-29.9%至-0.7%]；P =.04）和男性前列腺检查（45.2%对20.0%；变化-25.2%[95%CI，-45.4%至-5.1%]；P =.01）的使用差异也同样降低。有关节炎的持续未参保成年人报告称，符合医疗保险资格后，与关节炎相关的就诊次数和活动受限的增加幅度明显大于持续参保成年人，但关节炎治疗的增加幅度并非更大。在患有高血压的成年人中，符合医疗保险覆盖后持续未参保和参保成年人之间抗高血压药物的使用差异基本未变。
先前未参保的成年人在获得医疗保险覆盖后，大幅增加了对涵盖的基本临床服务的使用，但药物使用并未增加。为接近老年的未参保成年人提供一种可负担得起的购买医疗保险覆盖的选择可能会有类似效果。
