The Quarterly Journal of Economics · 2009 · 460 citations · 33 references
Public AffairsHealth PolicyHealth Services AdministrationGeriatric CareGeriatricsMedicare PolicyGeriatric EmergenciesInpatient CareLife ExpectancyMedicare AdvantageMortality ModelingAge Differences In UtilizationAge-based ThresholdsAge-specific Mortality ChangeAgeing TransitionChargesInpatient Admission RatesOld-age Mortality Estimation
Health insurance characteristics change at age 65 when most people become eligible for Medicare. The study measures how Medicare eligibility at 65 affects emergency‑department admissions for conditions with similar weekday and weekend rates. The analysis shows that while admission rates and comorbidities are smooth at 65, patients over 65 receive more procedures and incur higher charges, and experience a 1‑percentage‑point (≈20 %) reduction in 7‑day mortality that persists for at least nine months.
Health insurance characteristics shift at age 65 as most people become eligible for Medicare. We measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends. The age profiles of admissions and comorbidities for these patients are smooth at age 65, suggesting that the severity of illness is similar on either side of the Medicare threshold. In contrast, the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities, implying that patients over 65 receive more services. We estimate a nearly 1-percentage-point drop in 7-day mortality for patients at age 65, equivalent to a 20% reduction in deaths for this severely ill patient group. The mortality gap persists for at least 9 months after admission.
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Regression discontinuity designs: A guide to practice
Guido W. Imbens, Thomas Lemieux · Journal of Econometrics · 2007 · 3.8K citations
Health insurance and the demand for medical care: evidence from a randomized experiment.
Willard G. Manning, Joseph P. Newhouse, Naihua Duan et al. · PubMed · 1987 · 2.1K citations
Public Affairs, Economics, Insurance +17