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医疗保险覆盖范围能否改善癌症检测及死亡率结果?

Does Medicare Coverage Improve Cancer Detection and Mortality Outcomes?

作者信息

Myerson Rebecca M, Tucker-Seeley Reginald D, Goldman Dana P, Lakdawalla Darius N

出版信息

J Policy Anal Manage. 2020 Summer;39(3):577-604. doi: 10.1002/pam.22199. Epub 2020 Jan 12.

Abstract

Medicare is a large government health insurance program in the United States that covers about 60 million people. This paper analyzes the effects of Medicare insurance on health for a group of people in urgent need of medical care: people with cancer. We used a regression discontinuity design to assess impacts of near-universal Medicare insurance at age 65 on cancer detection and outcomes, using population-based cancer registries and vital statistics data. Our analysis focused on the three tumor sites for which screening is recommended both before and after age 65: breast, colorectal, and lung cancer. At age 65, cancer detection increased by 72 per 100,000 population among women and 33 per 100,000 population among men; cancer mortality also decreased by nine per 100,000 population for women but did not significantly change for men. In a placebo check, we found no comparable changes at age 65 in Canada. This study provides the first evidence to our knowledge that near-universal access to Medicare at age 65 is associated with improvements in population-level cancer mortality.

摘要

医疗保险是美国一项大型的政府医疗保险计划,覆盖约6000万人。本文分析了医疗保险对一群急需医疗护理的人群(癌症患者)健康状况的影响。我们采用回归断点设计,利用基于人群的癌症登记数据和人口统计数据,评估65岁时近乎全民覆盖的医疗保险对癌症检测及治疗结果的影响。我们的分析聚焦于65岁前后均建议进行筛查的三个肿瘤部位:乳腺癌、结直肠癌和肺癌。在65岁时,女性每10万人中的癌症检测率增加了72例,男性每10万人中的癌症检测率增加了33例;女性每10万人中的癌症死亡率也下降了9例,但男性的癌症死亡率没有显著变化。在一项安慰剂检验中,我们发现加拿大65岁人群没有类似变化。据我们所知,本研究首次提供了证据,表明65岁时近乎全民覆盖医疗保险与人群层面癌症死亡率的改善有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7f48/7318119/4176659b3371/PAM-39-577-g001.jpg

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