Dataset Information

Impact of Medicare Age Eligibility on Health Spending among U.S. and Foreign-Born Adults.

ABSTRACT: Examine differences in health care expenditures between foreign-born and U.S.-born adults in late mid-life, and how these differences change after age 65, when Medicare is near-universal.Medical Expenditures Panel Survey data (2000-2010) on adults ages 55-75 years (n = 46,132) to examine annual total and payer-specific expenditures.We use (1) propensity score matching to generate quasi-experimental samples with equivalent health needs and health care preferences, (2) generalized linear modeling to estimate group differences in expenditures, and (3) bootstrapping methods to obtain variance estimates for significance testing.Among adults ages 55-64, the foreign-born spend $3,314 (p < .001) less on health care, even when they have equivalent health needs and health care preferences. This difference is due mainly to lower spending through private insurance. After age 65, differences in total spending disappear but not differences in payer-specific spending. The foreign-born continue to spend significantly less through private insurance and begin to spend significantly more through Medicare and Medicaid.Foreign-born adults in late mid-life spend significantly less on health care than U.S.-born adults. After age 65, with near-universal Medicare coverage, differences in total spending disappear between the groups, although differences in spending by payer persist.

SUBMITTER: Tarraf W

PROVIDER: S-EPMC4874820 | biostudies-other | 2016 Jun

REPOSITORIES: biostudies-other

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Impact of Medicare Age Eligibility on Health Spending among U.S. and Foreign-Born Adults.

Tarraf Wassim W Jensen Gail A GA González Hector M HM

Health services research 20151020 3

<h4>Objective</h4>Examine differences in health care expenditures between foreign-born and U.S.-born adults in late mid-life, and how these differences change after age 65, when Medicare is near-universal.<h4>Data</h4>Medical Expenditures Panel Survey data (2000-2010) on adults ages 55-75 years (n = 46,132) to examine annual total and payer-specific expenditures.<h4>Study design</h4>We use (1) propensity score matching to generate quasi-experimental samples with equivalent health needs and healt ...[more]

PMID: 26487038

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Project description:BackgroundAsian Americans (AA) are the fastest growing ethnic group in the United States with high proportions of immigrants. Nativity is important as cancer risk factors vary by country. We sought to understand differences in cancer mortality among AAs by nativity (foreign-born vs. U.S.-born).MethodsNinety-eight thousand eight hundred and twenty-six AA (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) decedents with cancer-related deaths from U.S. death certificates (2008-2017) were analyzed. Thirteen cancers that contribute significantly to Asian-American cancer mortality were selected and categorized by etiology: tobacco-related, screen-detected, diet-/obesity-related, and infection-related. Ten-year age-adjusted mortality rates [AAMR; 95% confidence interval (CI); per 100,00] and standardized mortality ratios (SMR; 95% CI) using foreign-born as the reference group were calculated.ResultsOverall, foreign-born AAs had higher mortality rates than U.S.-born. Japanese U.S.-born males had the highest tobacco-related mortality rates [foreign-born AAMR: 43.02 (38.72, 47.31); U.S.-born AAMR: 55.38 (53.05, 57.72)]. Screen-detected death rates were higher for foreign-born than U.S.-born, except for among Japanese males [SMR 1.28 (1.21-1.35)]. Diet-/obesity-related AAMRs were higher among females than males and highest among foreign-born females. Foreign-born males and females had higher infection-related AAMRs than U.S.-born; the highest rates were foreign-born males-Korean [AAMR 41.54 (39.54, 43.53)] and Vietnamese [AAMR 41.39 (39.68, 43.09)].ConclusionsWe observed substantial heterogeneity in mortality rates across AA groups and by nativity. Contrary to the Healthy Immigrant Effect, most foreign-born Asians were dying at higher rates than U.S.-born AAs.ImpactDisaggregated analysis of AA cancers, targeted and culturally tailored cancer screening, and treatments for infections among foreign-born Asians is critical for cancer prevention efforts.

Project description:ObjectivesTo investigate the consequences of endogeneity bias on the estimated effect of having health insurance on health at age 63 or 64, just before most people qualify for Medicare, and to simulate the implications for total and public insurance (Medicare and Medicaid) spending on newly enrolled beneficiaries in their first years of Medicare coverage.DataThe longitudinal Health and Retirement Survey of people who were 55-61 years old in 1992, followed through biannual surveys to age 63-64 or until 2000 (whichever came first), and those who were 66-70 years olds from the Medicare Current Beneficiary Surveys, 1992-1998.Study designInstrumental variable (IV) estimation of a simultaneous equation model of insurance choice and health at age 63-64 as a function of baseline health and sociodemographic characteristics in 1992 and endogenous insurance coverage over the observation period.FindingsContinuous insurance coverage is associated with significantly fewer deaths prior to age 65 and, among those who survive, a significant upward shift in the distribution of health states from fair and poor health with disabilities to good to excellent health. Treating insurance coverage as endogenous increases the magnitude of the estimated effect of having insurance on improved health prior to age 65. The medical spending simulations suggest that if the near-elderly had continuous insurance coverage, average annual medical spending per capita for new Medicare beneficiaries in their first few years of coverage would be slightly lower because of the improvement in health status. In addition, total Medicare and Medicaid spending for new beneficiaries over their first few years of coverage would be about the same or slightly lower, even though more people survive to age 65.ConclusionsExtending insurance coverage to all Americans between the ages of 55 and 64 would improve health (increase survival and shift people from good-fair-poor health to excellent-very good health) at age 65, and possibly reduce total short-term spending by Medicare and Medicaid for newly eligible Medicare beneficiaries, even though more people would enter the program because of increased survival.

Dataset Information

Impact of Medicare Age Eligibility on Health Spending among U.S. and Foreign-Born Adults.

Publications

Impact of Medicare Age Eligibility on Health Spending among U.S. and Foreign-Born Adults.

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