San Diego State University, School of Public Health, San Diego, California.
J Am Geriatr Soc. 2020 Feb;68(2):388-394. doi: 10.1111/jgs.16238. Epub 2019 Oct 30.
Gaining Medicare eligibility at age 65 is associated with increased health insurance coverage and reduced medical expenditure risk, but few studies have examined changes in health outcomes among adults with a specific chronic condition. This study assessed the association between Medicare eligibility and health among adults with diabetes.
Regression discontinuity design to test for discontinuities in healthcare outcomes at age 65 when most US adults become eligible for Medicare.
National Health Interview Survey, 2006-2016.
Respondents ages 55 to 74 with diagnosed diabetes (n = 13 455).
Primary outcome measures included self-reported fair or poor general health status, any functional limitation, overweight, obese, and body mass index. Secondary outcomes included health insurance coverage, healthcare spending burden, and functional limitations by cause and type.
Medicare eligibility was associated with about an 8.0 percentage point reduction in the uninsured rate (95% confidence interval [CI], -9.9 to -6.0 percentage points; P < .001) and declines in high out-of-pocket healthcare expenditures and worry about medical bills. Eligibility was also associated with reductions of about 5.2 [95% CI, -6.9 to -3.6; P < .001] and 4.7 [95% CI, -7.1 to -2.3; P = .001] percentage points in fair or poor health and any functional limitation, respectively. Declines in functional limitations appeared to be driven by reductions in limitations due to diabetes, arthritis, heart problems, and emotional or behavioral problems. Some evidence indicated that Medicare eligibility was associated with a decline in obesity, but estimates were not consistently statistically significant.
Expanded health insurance coverage and gains in coverage quality may improve health outcomes among older adults with diabetes. J Am Geriatr Soc 68:388-394, 2020.
在 65 岁时获得医疗保险资格与增加医疗保险覆盖范围和降低医疗支出风险有关，但很少有研究检查过患有特定慢性病的成年人的健康结果变化。本研究评估了医疗保险资格与糖尿病成年人健康之间的关系。
使用回归不连续性设计来检验大多数美国成年人有资格获得医疗保险时，65 岁时医疗保健结果是否存在不连续性。
2006 年至 2016 年全国健康访谈调查。
年龄在 55 岁至 74 岁之间、被诊断患有糖尿病的受访者（n = 13455）。
主要结果测量包括自我报告的一般健康状况不佳、任何功能受限、超重、肥胖和体重指数。次要结果包括医疗保险覆盖范围、医疗保健支出负担以及按病因和类型划分的功能受限。
医疗保险资格与未参保率降低约 8.0 个百分点（95%置信区间，-9.9 至-6.0 个百分点；P<0.001）和高自付医疗费用以及担心医疗费用有关。资格获得也与健康状况不佳或任何功能受限分别降低约 5.2（95%置信区间，-6.9 至-3.6；P<0.001）和 4.7（95%置信区间，-7.1 至-2.3；P =.001）个百分点有关。功能受限的减少似乎是由于糖尿病、关节炎、心脏问题和情绪或行为问题导致的限制减少所致。有一些证据表明，医疗保险资格与肥胖率下降有关，但估计结果并不始终具有统计学意义。
扩大医疗保险覆盖范围和提高覆盖质量可能会改善老年糖尿病患者的健康结果。美国老年医学会 68:388-394,2020。
