National Center for Health Statistics, Hyattsville, MD 20782, USA.
Health Econ. 2012 Oct;21(10):1155-68. doi: 10.1002/hec.1780. Epub 2011 Aug 24.
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.
虽然已经表明，在 65 岁时获得医疗保险覆盖范围会增加无保险人群的卫生服务使用量，但习惯改变的困难或先前无保险人群与已保险人群的特征差异可能意味着，先前无保险人群继续以与其他人不同的方式使用医疗保健系统。本研究使用医疗保险索赔数据与两个不同的调查（国家健康访谈调查和健康与退休研究）相结合，描述了 65 岁之前的保险状况与 65 岁开始使用医疗保险覆盖服务之间的关系。尽管我们没有发现按先前保险状况划分的医疗保险支出或住院次数存在统计学上的显著差异，但我们确实发现，65 岁之前没有保险的人继续以与那些有私人保险的人不同的方式使用医疗保健系统。具体来说，他们到基层医疗机构的就诊次数减少了 16%，但到医院急诊和门诊的就诊次数分别增加了 18%和 43%。未来的一个关键问题可能是，为什么先前无保险的人似乎继续以与先前有保险的人不同的方式使用医疗保健系统。随着医疗保险覆盖范围的扩大，这个问题可能很重要。
