Yin Na
School of Public Affairs, Baruch College, City University of New York Institute for Demographic Research, One Bernard Baruch Way, New York, NY, USA.
Health Serv Res Manag Epidemiol. 2015 Feb 15;2:2333392815571583. doi: 10.1177/2333392815571583. eCollection 2015 Jan-Dec.
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.
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.
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.
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.
65岁以下的残疾人士有权通过社会保障残疾保险（DI）计划获得医疗保险，但前提是他们已完成两年的等待期。这是第一项使用纵向面板数据（健康与退休研究）的研究，旨在调查在医疗保险等待期内未参保的残疾受益人中，健康和经济状况是否以及在多大程度上受到影响。
在一项准实验研究设计中，我们使用差分估计法，比较了有替代公共医疗保险和没有替代公共医疗保险的残疾受益人进入DI计划前后的健康和经济结果变化。
调整后的差分估计表明，与参保的残疾受益人相比，等待期内未参保的残疾受益人报告健康状况不佳的可能性高13.6个百分点，健康状况极佳的可能性低6.3个百分点，在日常生活活动中宣称有更多困难，自付医疗费用高出30%。
研究结果突出了医疗保险等待期对未参保残疾受益人的惩罚性健康和经济影响。我们还讨论了研究结果对《平价医疗法案》改革的影响。
