Last week I posted in favor of expanding Medicare to cover more people before they reach the age of 65 due to the difficulty people in their 40’s and 50’s have in obtaining affordable coverage, especially if they have a history of medical problems. A study this week’s issue of The New England Journal of Medicine shows the need for providing care at an earlier age.
I often see patients without insurance avoid needed medical care until they reach the age of 65 and qualify for Medicare. The study verified that “Uninsured adults were significantly more likely than insured adults to report health declines before the age of 65 years.” As would be predicted, they also found that “Uninsured adults reported significantly fewer doctor visits and hospital stays than insured adults before age 65 .” The study concludes:
In this nationally representative longitudinal study, obtaining Medicare coverage at 65 years of age was associated with greater ncreases in doctor visits, hospital stays, and total medical expenditures for previously uninsured beneficiaries than for previously insured beneficiaries. Previously uninsured adults reported consistently greater use of health services and total medical expenditures after age 65 than previously insured adults with similar characteristics at ages 59 to 60 and comparable coverage after age 65. Self-reported use of health services for previously uninsured adults with cardiovascular disease or diabetes remained elevated through 72 years of age, indicating that the earlier lack of insurance was associated with persistent increases in health care needs rather than with transient spikes.These findings support the hypothesis that previously uninsured adults used health services more intensively and required costlier care as Medicare beneficiaries than they would have if previously insured.
The prognosis in problems such as diabetes is much better when treated aggressively at an earlier age, rather than waiting until the patient is 65. While the primary reason for expanding care would be to improve health, providing better coverage at an earlier age could also save money for Medicare. It is far more cost effective to care for diabetes and other chronic problems at an earlier stage as opposed to paying for cardiac bypass surgery, renal dialysis, and post-stroke care if treatment is delayed. I found it to be no surprise that the uninsured account for greater health care costs than the insured when first joining Medicare, but seeing that this effect lasts until at least age 72 could represent significant avoidable costs for the Medicare program.
The discussion in the study concludes:
Our findings have important policy implications. Near-elderly adults who were uninsured required more intensive and costlier care in the Medicare program after the age of 65 years than previously insured adults who were otherwise similar at ages 59 to 60. Therefore, providing health insurance coverage for uninsured near-elderly adults may improve their health outcomes and reduce their health care use and spending after age 65. Particularly for those with cardiovascular disease or diabetes, these benefits may be substantial and may partially offset the costs of expanding coverage.
