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Uninsured Benefit Once They Are Covered by Medicare

Study finds substantial improvement in a number of health conditions

THURSDAY, Dec. 27, 2007 (HealthDay News) -- People who are intermittently or totally uninsured in the decade prior to reaching Medicare eligibility experience substantial improvements in health once such coverage kicks in, a new study reveals.

In fact, previously uninsured people appeared to experience greater relative health gains during their post-65 Medicare years than did previously insured patients, particularly those diagnosed with heart disease and diabetes.

The findings suggest that Medicare dramatically reverses a trend toward rapid health deterioration among the previously uninsured "near-elderly," the study authors said.

"Our study shows that near-elderly adults -- those 55 to 64 -- who are uninsured have much greater declines in health before age 65," said co-author Dr. John Z. Ayanian, a professor of health care policy and medicine at Harvard Medical School and Brigham and Women's Hospital, both in Boston. "But once they become eligible for Medicare at 65, they do relatively better than people who were continuously insured before, in terms of improving their health."

The findings were reported in the Dec. 26 issue of the Journal of the American Medical Association.

To assess changes in health status among people before and after they entered into Medicare coverage, the authors analyzed data collected by the Health and Retirement Study, a national survey started in 1992.

Slightly more than 7,200 men and women participated. All were between the ages of 51 and 61 at the study's start, ensuring that the study cohort would include participants who would reach the age of Medicare eligibility (65) at some point through 2004.

Starting at age 55, the participants completed questionnaires on a biannual basis regarding their health insurance status, indicating whether they had lacked coverage at any point in the prior two years.

Those with continuous coverage prior to age 65 were classified as "insured." Among those reporting coverage gaps, men and women who had lacked insurance for more than half of the period between ages 55 and 64 were classified as "persistently uninsured." Those with some coverage beyond that threshold were classified as "intermittently uninsured."

Continuing until the age of 72, all participants were also asked to assess their general health status, reporting on their physical function abilities, mental health, pain experience, mobility, and depressive symptoms. The researchers ranked the responses, and assigned patients scores for all health issues.

Patients were also asked to indicate if they were diabetic and to report all incidences of heart attack, hospitalization for heart failure, and debilitative angina -- chest pain.

The study authors found that slightly more than 5,000 of the survey participants -- almost 70 percent -- had been continuously insured before receiving Medicare. Just over 2,200 were either intermittently or continuously uninsured between 55 and 64.

More than 60 percent of all the participants said they had been diagnosed with high blood pressure, heart disease, stroke, and/or diabetes prior to 65. Almost 70 percent of these patients had been insured, while the remainder were not.

Health status for the uninsured worsened at a much faster rate in the pre-Medicare years than for the insured, with the uninsured ultimately entering Medicare with far lower overall health scores than the insured.

However, once covered by Medicare, the health of the previously uninsured improved markedly, regardless of whether prior coverage had been non-existent or spotty. In fact, the uninsured group experienced no further declines in overall health during the Medicare years.

As a result, by age 70, the difference in overall health between the uninsured and the insured was half what had been expected, based on pre-Medicare trends. Agility and depression were two areas in which the previously uninsured showed greater significant improvement.

The researchers noted that much of the post-Medicare improvement in health among the previously uninsured was concentrated in the approximately 60 percent of people who'd been diagnosed with heart disease and/or diabetes before age 65.

Ayanian and his colleagues suggested that much of the improvement found among previously uninsured patients might derive from the improved management of blood pressure, glucose levels, and cholesterol levels. They concluded that offering earlier health coverage for people 55 and older would lead to substantial economic and social rewards.

"This clearly shows the benefits of Medicare coverage at age 65 for people who have been uninsured in their late 50s and early 60s, and it suggests that health coverage should be extended to all near-elderly adults before they become eligible for Medicare," Ayanian said.

Ayanian said the American College of Physicians has endorsed making Medicare coverage available to people before the age of 65.

David Schulke, executive vice president of the nonprofit, nonpartisan American Health Quality Association, said the study highlights a basic flaw in the current system.

"There is lasting harm done to the health of people who are uninsured, and they are sicker when they enter the Medicare program," he said. "This suggests that there will be a savings to the Medicare program if insurance coverage is created by Congress for people under the age of 65, because health care of the otherwise uninsured will improve, and they won't be so debilitated by the time they become eligible."

More information

To learn more about Medicare and the near-elderly, visit the Urban Institute.

SOURCES: John Z. Ayanian, M.D., M.P.P., professor, health policy and management, Harvard School of Public Health, and director, General Internal Medicine Fellowship, Brigham and Women's Hospital, Boston; David Schulke, executive vice president, American Health Quality Association, Washington, D.C.; Dec. 26, 2007, Journal of the American Medical Association
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