DELAYED HEALTH CARE AMONG THE NEAR-ELDERLY

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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.