Health Service Use among the Previously Uninsured: Is Subsidized Health Insurance Enough?

摘要

While it has been shown that gaining Medicare coverage at age 65 increases health service use among the uninsured, difficulty in changing habits or differences in characteristics of previously uninsured compared to insured individuals may mean that the previously uninsured continue to use the health care system differently from others. This study uses Medicare claims data linked to two different surveys – the National Health Interview Survey and the Health and Retirement Study - to describe the relationship between insurance status before age 65 and the use of Medicare-covered services beginning at age 65. Although we do not find statistically significant differences in Medicare expenditures or number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 continue to use the health care system differently from those who were privately insured. Specifically, they have 16% fewer visits to office-based physicians, while making 18% and 43% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured appear to continue to use the health care system differently from the previously insured. This question may be important to consider as health coverage expansions are implemented.