TY - JOUR T1 - Health of previously uninsured adults after acquiring Medicare coverage. JF - JAMA Y1 - 2007 A1 - J. Michael McWilliams A1 - Meara, Ellen A1 - Alan M. Zaslavsky A1 - John Z. Ayanian KW - Aged KW - Cardiovascular Diseases KW - depression KW - Diabetes Mellitus KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Medicare KW - Middle Aged KW - Outcome Assessment, Health Care KW - United States AB -

CONTEXT: Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes than insured adults. However, the health benefits of providing insurance coverage for uninsured adults have not been clearly demonstrated.

OBJECTIVE: To assess the effect of acquiring Medicare coverage on the health of previously uninsured adults.

DESIGN AND SETTING: We conducted quasi-experimental analyses of longitudinal survey data from 1992 through 2004 from the nationally representative Health and Retirement Study. We compared changes in health trends reported by previously uninsured and insured adults after they acquired Medicare coverage at age 65 years.

PARTICIPANTS: Five thousand six adults who were continuously insured and 2227 adults who were persistently or intermittently uninsured from ages 55 to 64 years.

MAIN OUTCOME MEASURES: Differential changes in self-reported trends after age 65 years in general health, change in general health, mobility, agility, pain, depressive symptoms, and a summary measure of these 6 domains; and adverse cardiovascular outcomes (all trend changes reported in health scores per year).

RESULTS: Compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65 years for the summary measure (differential change in annual trend, +0.20; P = .002) and several component measures. Relative to previously insured adults with cardiovascular disease or diabetes, previously uninsured adults with these conditions reported significantly improved trends in summary health (differential change in annual trend, +0.26; P = .006), change in general health (+0.02; P = .03), mobility (+0.04; P = .05), agility (+0.08; P = .003), and adverse cardiovascular outcomes (-0.015; P = .02) but not in depressive symptoms (+0.04; P = .32). Previously uninsured adults without these conditions reported differential improvement in depressive symptoms (+0.08; P = .002) but not in summary health (+0.10; P = .17) or any other measure. By age 70 years, the expected difference in summary health between previously uninsured and insured adults with cardiovascular disease or diabetes was reduced by 50%.

CONCLUSION: In this study, acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.

PB - 298 VL - 298 IS - 24 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18159058?dopt=Abstract U4 - Medicare/Insured Status/SELF-RATED HEALTH ER - TY - JOUR T1 - Health insurance coverage and mortality among the near-elderly. JF - Health Aff (Millwood) Y1 - 2004 A1 - J. Michael McWilliams A1 - Alan M. Zaslavsky A1 - Meara, Ellen A1 - John Z. Ayanian KW - Cohort Studies KW - Female KW - health policy KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Middle Aged KW - Mortality KW - United States AB -

Uninsured near-elderly people may be particularly at risk for adverse health outcomes. We compared mortality of a nationally representative cohort of insured and uninsured near-elderly people with stratification by race; income; and the presence of diabetes, hypertension, or heart disease, using propensity-score methods to adjust for numerous characteristics. Lacking health insurance was associated with substantially higher adjusted mortality among adults who were white; had low incomes; or had diabetes, hypertension, or heart disease. Expanding coverage to the near-elderly uninsured may greatly improve health outcomes for these groups.

PB - 23 VL - 23 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15318584?dopt=Abstract U4 - Health Insurance Coverage/Elderly/Mortality ER -