DELAYED HEALTH CARE AMONG THE NEAR-ELDERLY

描述(申请人提供)：在55岁至之间的美国成年人中，近10%的人没有医疗保险。在少数群体和受教育程度较低的个人中，覆盖率不足的情况更加明显。以前的研究已经证明，65岁时医疗保健利用率显著增加，这表明没有医疗保险减少了近老年人对所需卫生保健服务的利用。然而，使这一推论复杂化的是，测量到的服务利用率增加的一小部分可能代表着65岁左右保健服务时间的战略性延迟。如果患者和医疗保健提供者有经济动机将对65岁以下的人进行昂贵的治疗推迟到65岁之后，那么战略上的延迟是可能的。在这种延误发生的程度上，65岁时卫生保健利用率的一些可测量的跃升可能反映了对时机的战略选择，而不是65岁之前提供的治疗不足的直接证据。我们建议使用加利福尼亚州和佛罗里达州的机密医院出院记录来(1)估计65岁以下患者治疗的战略性延误的程度；(2)确定哪些类型的住院治疗显示出战略性延误的最多证据；(3)确定战略性延误是否因种族和民族以及65岁之前的保险覆盖率而异；(4)确定战略性延误是否与医院和当地市场特征有关；以及(5)分析战略性延误对联邦医疗保险计划的成本负担的影响。

DESCRIPTION (provided by applicant): Nearly 10 percent of adult Americans between the ages of 55 and 64 lack health insurance. The shortfall in coverage is even more pronounced among minorities and individuals with lower levels of education. Previous research has documented a significant increase in health care utilization at age 65, which suggests that the absence of health insurance reduces the utilization of needed health care services among the near elderly. However, complicating this inference is the possibility that some fraction of the measured increase in service utilization represents strategic delay in the timing of health care services around age 65. Strategic delay is likely if patients and health care providers have financial incentives to delay expensive treatments for people who are just under 65 until after their 65th birthday. To the extent that such delays occur, some of the measured jump in health care utilization at age 65 may reflect the strategic choice of timing, rather than direct evidence of under-provision of treatment prior to age 65. We propose to use confidential hospital discharge records from the states of California and Florida to (1) estimate the extent of strategic delay in the treatment of patients just under age 65; (2) determine which types of hospital admissions show the most evidence of strategic delay; (3) determine whether strategic delay varies by race and ethnicity and rates of insurance coverage prior to turning 65; (4) determine if strategic delay is related to hospital and local market characteristics; and (5) analyze the implications of strategic delay for the cost burden of the Medicare program.