Commentary: assessing the health effects of Medicare coverage for previously uninsured adults: a matter of life and death?

Health Serv Res. 2010 Oct;45(5 Pt 1):1407-22; discussion 1423-9. doi: 10.1111/j.1475-6773.2010.01085.x.

Abstract

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.

Publication types

  • Comment
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Health Services Research
  • Health Status*
  • Humans
  • Insurance Coverage / organization & administration*
  • Medically Uninsured / statistics & numerical data*
  • Medicare / organization & administration*
  • Middle Aged
  • Mortality
  • Proportional Hazards Models
  • Research Design
  • United States / epidemiology