|Medicare expenditure growth and its health returns across cohorts
|Year of Publication
|Rutgers, The State University of New Jersey
|New Brunswick, NJ
|Consumption and Savings, Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Public Policy
There are several key findings in the following chapters. In Chapter 2, the individual characteristics associated with higher spending growth over the period 1996 to 2008 were identified based on analyses with pooled cross-sectional data from the Medical Expenditure Panel Survey. The key factors that were associated with the adjusted growth rates higher than the actual Medicare spending growth rate (5.8% annually) from 1996 to 2008 include races other than the whites and blacks, Hispanic origin, high income, residence in the West, and very good health status. Findings from Chapter 3 reveal that enrollment in HMOs under Medicare is not random, but is systematically related to characteristics of Medicare enrollees. Using the longitudinal Health and Retirement Study, there were factors associated with a higher likelihood of becoming enrolled in Medicare Advantage/Part C. Chapter 4 examines the relationship between health care spending and returns to health with regard to five dimensions of health: mortality, hypertension, arthritis, self-assessed health status and mental health status (Center for Epidemiologic Studies Depression scale, CESD scale). The pre-Medicare characteristics were used to predict the change in these five dimensions of health after four years of Medicare coverage. The results reveal that increases in Medicare total and out-of-pocket spending were associated with poor health outcomes. Total spending was associated with a higher likelihood of death, worse self-rated health status (five categories) and mental health status. The increase in out-of-pocket health expenditure was associated with a higher chance of getting a worse category in self-rated health status after controlling for health status and other characteristics before being enrolled in Medicare. The findings of these studies suggest that policies to constrain Medicare spending should recognize and target the multiple factors contributing to Medicare expenditure growth and the dubious returns to health, as well as target integrated care for Medicare enrollees and incentives for individuals to prevent the onset of chronic health conditions.