Improvements in Health for Uninsured Adults after obtaining Medicare

This quasi-experimental study of self-reported health status of uninsured near-elderly (55-64 years) adults demonstrated the striking positive effect of achieving Medicare eligibility at age 65. Throughout life there is a natural decline in health status and function, on average, for all people – whether insured or not. This rate of decline is greatest for those individuals without insurance coverage (and therefore lack of access to primary care, pharmaceuticals, and other medical interventions). However, after reaching age 65 (and thus, eligibility for Medicare) the declining trend in health status improves for previously uninsured populations – especially those with cardiovascular conditions or diabetes. The authors estimate that for every 10 patients with pre-existing cardiovascular disease or diabetes who were uninsured prior to reaching Medicare eligibility, 1 cardiovascular outcome (heart attack, angina, or hospitalization for congestive heart failure) would be averted over the next 7 years.

Commentary:

This research adds to the volume of data suggesting the ills of uninsurance. It also suggests that adverse outcomes could be avoided if uninsured near elderly patients were insured earlier than age 65. The number needed to treat appears to be 70 patient-years of insurance. At the current rate of Medicare expenditures, this approximates to $700,000 per averted adverse event. Unfortunately, this amount presently exceeds what researchers commonly consider favorable for a cost-benefit analysis.

JAMA. 2007;298(24):2886-2894.

by

Cedric K. Dark, MD, MPH