The Impact of Medicare on Individual Longevity: Evidence from Medicare Introduction Using Big Data

项目摘要 先前的研究报告称，医疗保险计划并没有导致死亡率的显著下降， 但需要立即住院的重病患者和残疾人除外。但没有一个 之前的研究已经估计了获得联邦医疗保险计划的终生影响-他们只 调查了它的短期影响。在其他情况下，先前的研究发现，短期评估可以 错过了重要的长期影响。在影响保健服务获得的政策方面，这一问题尤其突出。 很重要。因为联邦医疗保险涵盖重要的预防性护理，并帮助参与者管理慢性疾病 在这种情况下，获得医疗保险的累积影响可能是巨大的，即使其短期影响是 有限的。该项目的主要目标是评估医疗保险对老年人寿命的长期影响。 人口作为一个整体和不同的亚群。以往的工作往往局限于对异质性的研究。 因为它依赖于公布的总死亡率，这些总死亡率只按地理、性别、 种族/族裔和年龄，但不是以任何其他社会经济地位的衡量标准。因此，存在着知识鸿沟 关于医疗保险对个人(完全)寿命的终生影响以及这一影响是否因不同而不同 社会经济团体。拟议的探索性项目将审查引入联邦医疗保险对 受影响人群的寿命。当医疗保险在1966年7月生效时，它创造了不同的年龄 联邦医疗保险的第一代接受者何时获得联邦医疗保险：例如，1902年出生的人 出生于1891年的人在65岁时获得资格，而1891年出生的人在75岁时获得资格。这个项目将使用一个大型和 新创建的数据集，将美国人口普查与家谱数据联系起来。据我们所知，这个数据集将是 美国迄今为止最大的数据集，包含关于个人寿命以及个人寿命的信息 社会经济特征。这项研究将首先检查医疗保险对年度死亡率的短期影响 评级，重新评估以前的研究，但使用个人水平的数据，并扩展结果以查看影响 各亚组之间(目标1)。然后，这个项目将调查累积的长期影响 通过比较不同年龄参加医疗保险的个人的平均寿命，得出医疗保险对长寿的影响 使用中断的时间序列分析，针对所有人并按分组(目标2)。最后，该项目将利用 在医疗保险推出之前，私人医疗保险的地理和个人差异，以估计 医疗保险对寿命的因果影响(目标3)。将使用差异性战略：我们将 评估在65岁或65岁以上获得医疗保险的群体的寿命变化是否 对于那些已经有可能拥有私人医疗保险的人来说，无论是因为他们的地理位置 或者他们的个人特征。分析将根据职业、教育程度、 收入，以及其他衡量社会经济地位的指标。

PROJECT ABSTRACT Prior studies have reported that the Medicare program does not result in significant declines of mortality rates, except among severely ill patients who require immediate hospitalization and among the disabled. But none of the previous studies has estimated the lifetime effects of having access to the Medicare program—they only investigated its short-term impacts. In other contexts, prior research has found that short-term evaluations can miss important long-term effects. In the case of policies affecting health care access, this issue is particularly important. Because Medicare covers important preventive care and helps participants to manage chronic conditions, the cumulative impact of having access to Medicare might be big, even if its short-term impact is limited. The main goal of this project is to estimate the long-term impact of Medicare on longevity for the population as a whole and various subgroups. Prior work is often limited in its investigation of heterogeneity because it relies on published aggregate mortality rates which are only broken down by geography, gender, race/ethnicity, and age, but not by any other measure of socioeconomic status. Thus, a knowledge gap exists on the lifetime effect of Medicare on individual (completed) longevity and whether this varies across socioeconomic groups. The proposed exploratory project will examine the impact of Medicare’s introduction on the longevity of the affected cohorts. When Medicare took effect in July 1966, it created variations in the age when Medicare’s first-generation recipients gained Medicare coverage: for example, those born in 1902 became eligible at 65 whereas those born in 1891 gained eligibility at age 75. This project will use a large and newly created dataset that links the US census with genealogical data. To our knowledge, this dataset will be the largest dataset to date in the US containing information on both individual longevity as well as individual socioeconomic characteristics. This study will first examine Medicare’s short-term effects on annual mortality rates, reevaluating previous studies but using individual-level data, and extending the results to look at effects among various subgroups (Aim 1). Then, this project will investigate the cumulative long-term effect of Medicare on longevity by comparing the average longevity of individuals who gained Medicare at different ages using an interrupted time-series analysis, for all and by subgroup (Aim 2). Finally, the project will leverage geographic and individual variation in private health insurance before Medicare’s introduction to estimate the causal lifetime effect of Medicare on longevity (Aim 3). A difference-in-differences strategy will be used: we will assess if the changes in longevity for groups who gained Medicare coverage at age 65 or at older ages are greater for those who were already likely to have private health insurance, either because of their geographic location or their personal characteristics. The analysis will be repeated based on occupation, education, income, and other measures of socioeconomic status.