DELAYED HEALTH CARE AMONG THE NEAR-ELDERLY

描述（由申请人提供）：近10%的55岁至64岁的美国成年人没有医疗保险。在少数民族和受教育程度较低的个人中，覆盖率的不足更为明显。先前的研究记录了65岁时医疗保健利用的显著增加，这表明缺乏医疗保险减少了近老年人对所需医疗保健服务的利用。然而，使这一推断更加复杂的是，在服务利用率的测量增长中，有一部分可能是65岁左右获得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岁生日之后，就有可能出现战略性延迟。在这种延迟发生的程度上，65岁时保健利用的一些可测量的跳跃可能反映了时机的战略选择，而不是65岁之前治疗提供不足的直接证据。我们建议使用来自加利福尼亚州和佛罗里达州的保密出院记录来(1)估计65岁以下患者治疗的战略延迟程度；(2)确定哪些类型的住院表现出最明显的战略延误；(3)确定战略延迟是否因种族和民族以及65岁之前的保险覆盖率而变化；(4)确定战略延迟是否与医院和当地市场特征有关；(5)分析战略延迟对医疗保险计划成本负担的影响。

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.