Department of Health Care Policy, Harvard Medical School, and Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Health Serv Res. 2010 Oct;45(5 Pt 1):1407-22; discussion 1423-9. doi: 10.1111/j.1475-6773.2010.01085.x.
In contrast to a previous study we conducted and other evidence, a recent study found no significant effects of Medicare coverage after age 65 on overall health for previously uninsured adults and significant adverse effects on survival for some of these adults. We discuss explanations for these inconsistent findings, particularly the different ways in which deaths were handled, a key methodological challenge in longitudinal analyses of health. We demonstrate that analytic approaches suitable for examining effects of coverage on health measures may not be suitable for effects on mortality. Thus, estimates may be misleading when these different outcomes are jointly modeled. We also present new survival analyses that suggest Medicare coverage significantly attenuated the rising risk of death for previously uninsured adults.
与我们之前进行的一项研究和其他证据相反，最近的一项研究发现，对于以前没有医疗保险的成年人来说，65 岁以后的医疗保险覆盖范围并没有显著影响整体健康，而且对其中一些成年人的生存有显著的不利影响。我们讨论了这些不一致的发现的解释，特别是在对健康指标进行纵向分析时，处理死亡的不同方式，这是一个关键的方法学挑战。我们证明，适用于检查覆盖范围对健康指标影响的分析方法可能不适用于对死亡率的影响。因此，当这些不同的结果被联合建模时，估计可能会产生误导。我们还提出了新的生存分析，表明医疗保险覆盖显著降低了以前没有医疗保险的成年人死亡风险的上升。
