Impact of Medicare on Utilization and Health Disparities

描述(由申请人提供)：联邦医疗保险计划为老年人提供几乎全民的医疗保险。医疗保险资格的开始与获得门诊护理的群体间差距的下降和住院率的上升有关。然而，令人惊讶的是，非洲裔美国人在65岁时的住院率以及包括髋关节和膝盖置换在内的特定手术的住院率的增幅比白人小得多。因此，医疗保险似乎对医疗保健使用的差异产生了模棱两可的影响。我们提出了一系列项目，以研究随着个人达到医疗保险资格年龄而发生的卫生保健利用和健康的变化，并分析这些变化对种族和民族在卫生利用和健康方面的差异程度的影响。具体地说，我们建议：1.分析西班牙裔、黑人和白人在主要健康状况下65岁时住院和门诊手术比率的变化，并记录不同群体之间的相对变化如何随着疾病的性质以及患者、提供者和机构的特征而变化。2.估计住院治疗的强度是否因享受医疗保险的资格而不同，这些差异是否影响死亡率，以及不同族裔/种族群体的治疗强度变化是否不同。3.使用面板数据集估计65岁对拉美裔、黑人和白人健康、身体功能和生活质量的替代指标的影响。4.检查不同群体在医疗保险覆盖的头几年中利用医疗保健服务的差异，并测试对这些差异的其他解释，包括补充保险覆盖的作用。

DESCRIPTION (provided by applicant): The Medicare program provides nearly universal health insurance coverage for the elderly. The onset of Medicare eligibility is associated with a drop in inter-group disparities in access to ambulatory care and a rise in hospital admission rates. Surprisingly, however, African Americans experience much smaller increases than whites in rates of hospitalization at age 65, and in rates for specific procedures including hip and knee replacements. Thus, Medicare appears to have an ambiguous effect on disparities in healthcare use. We propose a series of projects to study the changes in health care utilization and health that occur as individuals reach the age of Medicare eligibility, and analyze the effects of these changes on the extent of racial and ethnic disparities in health utilization and health. Specifically, we propose to: 1. Analyze the changes in rates of inpatient admissions and outpatient procedures occurring at age 65 for Hispanics, blacks, and whites across major health conditions, and document how the relative changes across groups vary with the nature of the condition and with the characteristics of patients, providers, and institutions. 2. Estimate whether the intensity of hospital treatment varies with eligibility for Medicare, whether these differences affect mortality, and whether the changes in intensity of treatment are different for different ethnic/racial groups. 3. Use panel data sets to estimate the impacts of reaching age 65 on alternative measures of health, physical functioning, and quality of life for Hispanics, blacks and whites. 4. Examine differences across groups in the utilization of health care services in the first few years of Medicare coverage, and test alternative explanations for these differences, including the role of supplemental insurance coverage.