Card David, Dobkin Carlos, Maestas Nicole
University of California, Berkeley.
Q J Econ. 2009;124(2):597-636. doi: 10.1162/qjec.2009.124.2.597.
Health insurance characteristics shift at age 65 as most people become eligible for Medicare. We measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends. The age profiles of admissions and comorbidities for these patients are smooth at age 65, suggesting that the severity of illness is similar on either side of the Medicare threshold. In contrast, the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities, implying that patients over 65 receive more services. We estimate a nearly 1-percentage-point drop in 7-day mortality for patients at age 65, equivalent to a 20% reduction in deaths for this severely ill patient group. The mortality gap persists for at least 9 months after admission.
随着大多数人年满65岁有资格享受医疗保险，健康保险特征会发生变化。我们衡量了这些变化对通过急诊科入院治疗的患者的影响，这些患者在工作日和周末的入院率相似。这些患者的入院年龄分布和合并症在65岁时较为平滑，这表明在医疗保险门槛两侧，疾病严重程度相似。相比之下，医院进行的手术数量和总费用清单显示出虽小但在统计上显著的不连续性，这意味着65岁以上的患者接受了更多服务。我们估计65岁患者的7天死亡率下降了近1个百分点，相当于该重症患者群体死亡人数减少了20%。入院后，死亡率差距至少持续9个月。
