The Impact of Medicare Coverage on Downstream Financial Outcomes for Adults Who Undergo Surgery

Abstract

Objective: To evaluate the effects of gaining access to Medicare on key financial outcomes for surgical patients. Summary Background Data: Surgical care poses a significant financial burden, especially among patients with insufficient financial risk protection. Medicare may mitigate the risk of these adverse circumstances, but the impact of Medicare eligibility on surgical patients remains poorly understood. Methods: Regression discontinuity analysis of national, cross-sectional survey and cost data from the 2008 to 2018 National Health Interview Survey and Medical Expenditure Panel Survey. Patients were between the ages of 57 to 72 with surgery in the past 12 months. The primary outcomes were the presence of medical debt, delay/deferment of care due to cost, total annual out-of-pocket costs, and experiencing catastrophic health expenditures. Results: Among 45,982,243 National Health Interview Survey patients, Medicare eligibility was associated with a 6.6 percentage-point decrease (95% confidence interval [CI]: -9.0% to -4.3) in being uninsured (>99% relative reduction), 7.6 percentage-point decrease (24% relative reduction) in having medical debt (95%CI: -14.1% to -1.1%), and 4.9 percentage-point decrease (95%CI: -9.4% to -0.4%) in deferrals/delays in medical care due to cost (28% relative reduction).

Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture

“…This age range was chosen to identify DRF management patterns before and after age 65 years, consistent with prior RDD investigations of changes in health care use at time of Medicare eligibility. 25,31,32 Patients with missing data on age, race and ethnicity, insurance type, or linkage variables were excluded. To isolate the outcome of Medicare eligibility at age 65 years, individuals who obtained Medicare coverage before reaching age 65 years were excluded from the primary analysis.…”

Quasi-Experimental Design for Health Policy Research: A Methodology Overview

“…12 For each design, examples beyond those in the narrative may be found in Table 1. [13][14][15][16][17][18][19][20][21][22]…”

Insurance and Transformation of Risk

“…From Neiman et al, we learn that compliant participation in the Medicare program led almost all eligible persons to being insured (a good yield in the direction expected), to being nearly 25% less likely to experience medical debt, and to being nearly 30% less likely to delay or defer care (compared to other adults just under the age of eligibility). 1 We know now the general features of Medicare coverage, but we know also the liability transformation profile is complex and hugely variable across types of service expense, and it is difficult for us to identify which features of the program had the largest effect on these positive directions. Gaining access nearly eliminated ''uninsured'' status, but ''insured'' status tells us virtually nothing about the effectiveness of the program's risk transformation.…”

“…In The Impact of Medicare Coverage on Downstream Financial Outcomes for Adults Who Undergo Surgery, Neiman et al applied a regression discontinuity design to 11 years of data (2008–2018) representing more than 30 million surgical patients (inpatient minor or major surgery within the past year) from 2 data sources (National Health Interview Survey [NHIS] and Medical Expenditure Panel Survey [MEPS]), to address the question of how the natural experiment of Medicare eligibility at age 65 in the United States affects a variety of metrics 1 . These included: from NHIS data – uninsurance rates, medical debt, altered medications, unmet need for care, deferral or delay of care; and from MEPS data – out-of-pocket (OOP) spending, catastrophic health expenditures (CHE), and total provider charges.…”

“…In The Impact of Medicare Coverage on Downstream Financial Outcomes for Adults Who Undergo Surgery, Neiman et al applied a regression discontinuity design to 11 years of data (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) representing more than 30 million surgical patients (inpatient minor or major surgery within the past year) from 2 data sources (National Health Interview Survey [NHIS] and Medical Expenditure Panel Survey [MEPS]), to address the question of how the natural experiment of Medicare eligibility at age 65 in the United States affects a variety of metrics. 1 These included: from NHIS datauninsurance rates, medical debt, altered medications, unmet need for care, deferral or delay of care; and from MEPS data -out-of-pocket (OOP) spending, catastrophic health expenditures (CHE), and total provider charges. The investigators found that individuals who underwent surgery after age 65, and thus in most cases after becoming eligible for Medicare coverage, were almost all insured, nearly 25% less likely to experience medical debt, and nearly 30% less likely to delay or defer care compared to other adults just under the age of Medicare eligibility.…”