Access to Care

Patients who were uninsured use more medical services once they enroll in Medicare

Previously uninsured adults, especially those with chronic conditions, visit doctors and end up in hospitals more often once they enroll in Medicare. Those diagnosed with high blood pressure, diabetes, heart disease, or stroke had more doctor visits, hospital stays, and care costs once they enrolled in Medicare than adults with the same conditions who had medical insurance before their Medicare eligibility, according to a new study by Harvard Medical School researchers.

Using data from the Health and Retirement Study, which has tracked the same 9,760 adults and their spouses since 1992, they looked at 5,158 study participants who were 65 years and older by 2004. Nearly three-fourths (73 percent) had private insurance before Medicare, while 27 percent did not. Previously uninsured adults, especially those with cardiovascular disease or diabetes, reported greater use of health care services after age 65.

Because the uninsured group lacked regular care before turning 65, they were likely undertreated for conditions like high blood pressure and high cholesterol, resulting in poor health and a need for services once they enrolled in Medicare, the researchers suggest.

The cost of permitting uninsured adults to purchase Medicare coverage before they hit 65 may improve this group's health. It could also reduce Medicare use and expenses once that population reaches 65, especially if cardiovascular disease or diabetes are factors. These conditions, if left uncontrolled, can cause life-threatening heart attacks or strokes or lead to kidney disease or congestive heart failure. All of these problems magnify the need for hospitalizations, ambulatory care, medications, and procedures.

This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00020).

See "Use of health services by previously uninsured Medicare beneficiaries," by J. Michael McWilliams, M.D., Ellen Meara, Ph.D., Alan M. Zaslavsky, Ph.D., and John Z. Ayanian, M.D., M.P.P., in the July 12, 2007, New England Journal of Medicine 357(2), pp. 143-153.

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