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

项目摘要 先前的研究报告说，医疗保险计划并没有导致死亡率的显着下降， 除了需要立即住院的重病患者和残疾人。但没有一 以前的研究估计了获得医疗保险计划的终身影响-他们只 研究其短期影响。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。就影响获得保健服务的政策而言，这一问题尤其重要。 重要.因为医疗保险涵盖了重要的预防性护理，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很大，即使其短期影响是有限的。 有限公司该项目的主要目标是估计医疗保险对寿命的长期影响， 人口作为一个整体和各种亚组。以前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，而这些死亡率只是按地理，性别， 种族/民族和年龄，但不是通过任何其他衡量社会经济地位的标准。因此，存在知识差距 关于医疗保险对个人（完成）寿命的终身影响，以及这种影响是否在 社会经济群体。拟议的探索性项目将研究医疗保险的引入对 受影响群体的寿命。当医疗保险在1966年7月生效时， 当医疗保险的第一代接受者获得医疗保险覆盖时：例如，1902年出生的人 1891年出生的人在75岁时获得资格。该项目将使用大型和 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，包含个人寿命和个人 社会经济特征这项研究将首先检查医疗保险对年死亡率的短期影响 率，重新评估以前的研究，但使用个人水平的数据，并扩展结果，看看效果 在不同的分组中（目标1）。然后，本项目将调查 通过比较在不同年龄获得医疗保险的个人的平均寿命， 使用中断的时间序列分析，对所有人和亚组（目标2）。最后，该项目将利用 在医疗保险引入之前，私人医疗保险的地理和个人差异， 医疗保险对寿命的因果寿命效应（目标3）。将采用差异化战略：我们将 评估在65岁或更高年龄获得医疗保险的人群的寿命变化是否 对于那些已经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， 位置或个人特征。将根据职业、教育、 收入和其他社会经济地位的衡量标准。

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.