Background: Medicare coverage at age 65 improves access to and use of care and alleviates financial hardship for the general population. However, less is known whether the effects differ between individuals without and with functional disability.

Objectives: To examine the effects of Medicare eligibility at age 65 on health insurance coverage, financial burden of care, and access to care among individuals without and with functional disability.

Design: We used a regression discontinuity design, which exploits the discontinuity in eligibility for Medicare at age 65 and compares individuals just before and after age 65.

Participants: Our analysis included 19,876 individuals (aged 59-71) without functional disability and 8376 individuals with functional disability from the 2014-2021 Medical Expenditure Panel Survey.

Main measures: We assessed health insurance coverage, financial burden of care, and access to care.

Results: Medicare eligibility led to increases in any and Medicare coverage for both groups, but those with functional disability had a decrease in Medicaid coverage by - 2.6 percentage points. Medicare eligibility resulted in lower financial burden of care for both groups, but the effects were greater among those with functional disability (- $578 vs. - $344 for out-of-pocket spending, - 3.7 vs. - 4.9 percentage points for cost-sharing, and - 2.5 vs. - 0.8 percentage points for paying medical bills over time). Although Medicare eligibility led to a decrease in delayed medical care among those without functional disability (- 2.1 percentage points), no change was observed among those with functional disability. Notably, access to care remained limited among those with functional disability after obtaining Medicare eligibility (8.6% and 3.9% for being unable to get medical care and experiencing delay in getting medical care).

Conclusion: Medicare coverage can reduce financial hardship, especially for individuals with functional disability. However, there is a need to develop policies that ensure equitable access to care for those with functional disability.

Keywords: access to care; financial burden; functional disability; medicare; regression discontinuity.

© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

背景:

65岁获得医疗保险资格可以改善一般人群的医疗访问和使用情况，并减轻他们的经济负担。然而，目前尚不清楚这种效果是否在没有功能障碍和有功能障碍的人之间存在差异。

目的:

研究65岁时医疗保险资格对无功能障碍及有功能障碍个体健康保险覆盖、医疗费用负担以及医疗服务获取的影响。

设计:

我们采用回归不连续性设计，利用在65岁处医疗保险资格的间断性，对比分析接近但未满65岁和刚过65岁的个人情况。

参与者:

我们的分析包括2014年至2021年医疗支出面板调查中19,876名（年龄在59至71岁之间）无功能障碍的个体以及8376名有功能障碍的个体。

主要测量指标:

我们评估了健康保险覆盖、护理费用负担和医疗访问情况。

结果:

医疗保险资格使两个群体的任何类型以及特定于Medicare的保险覆盖率均有所增加，但功能障碍者中Medicaid覆盖减少2.6个百分点。医疗保险资格对所有人的护理财务压力都有所减轻，但在有功能障碍的人群中这种效果更为显著（自费支出减少了578美元对比344美元，成本分担方面分别下降了3.7和4.9个百分点，拖欠医疗账单的比例也从2.5和0.8个百分点不等）。尽管医疗保险资格导致无功能障碍人群延迟就医的情况减少（2.1个百分点），但在有功能障碍的人群中未观察到变化。值得注意的是，在获得Medicare资格后，有功能障碍的个人仍面临受限的医疗访问情况（无法获取医疗服务的比例为8.6%，经历延迟治疗的比例为3.9%）。

结论:

医疗保险可以减轻经济负担，特别是对于有功能障碍的人群。然而，需要制定政策以确保这些人群能够公平获得医疗资源。

关键词:

医疗访问；财务负担；功能性残疾；Medicare；回归不连续性。