People who were previously uninsured and then got Medicare coverage enjoyed better health, particularly people with diabetes and cardiovascular disease, says an article in the Journal of the American Medical Association (JAMA), December 26th issue.

The authors explain "Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes and use more health services as Medicare beneficiaries after age 65 years than insured near-elderly adults. Because chronic diseases are prevalent and insurance coverage is often unaffordable for older uninsured adults, the impact of near-universal Medicare coverage at age 65 years on the health of previously uninsured adults may be substantial."

J. Michael McWilliams, M.D., Brigham and Women's Hospital and Harvard Medical School, Boston, and team examined the association of receiving Medicare coverage at 65 with trends in self-reported health outcomes for people aged 55-72 years for adults who were previously uninsured, particularly people with diabetes and cardiovascular disease. They assessed survey data, gathered from 1992 to 2004, from the nationally representative Health and Retirement Study, comprising 5,006 adults who were always insured and 2,227 adults who were persistently or occasionally uninsured from 55 to 64 years of age.

The researchers compared changes in health trends for adults who were previously uninsured and insured after they received Medicare coverage at 65 years of age. The survey covered general health, change in general health, mobility, agility, pain, depression, a summary of these, as well as adverse cardiovascular outcomes.

The authors write that before 65 years of age summary health scores got worse at a greater rate for uninsured adults, compared to insured adults - they were substantially worse at 65 years of age. Previously uninsured adults reported substantially improved health trends after 65 for the summary measure and several component measures, compared to previously insured adults.

The improvements for previously uninsured adults with diabetes or cardiovascular disease were significant for summary health, change in general health, mobility, agility, and adverse cardiovascular outcomes, compared to previously insured adults. However, this was not the case for depressive symptoms.

On the other hand, adults who were previously uninsured reported improvements in depressive symptoms but not in summary health or any of the other measures. By the time those in the survey reached the age of 70 the expected difference in summary health for patients with cardiovascular disease or diabetes was reduced by 50% when previously uninsured and previously insured people were compared.

The researchers concluded "Our findings have important policy implications. Proposals to extend insurance coverage to uninsured near-elderly adults have been introduced in the U.S. Congress and endorsed by the American College of Physicians. Providing earlier health insurance coverage for uninsured adults, particularly those with cardiovascular disease or diabetes, may have considerable social and economic value for the United States by improving health outcomes."

"Health of Previously Uninsured Adults After Acquiring Medicare Coverage"
J. Michael McWilliams, MD; Ellen Meara, PhD; Alan M. Zaslavsky, PhD; John Z. Ayanian, MD, MPP
JAMA. 2007;298(24):2886-2894.
Click here to view abstract online



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