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In the United States, people over 65 years of age become eligible for Medicare, a national health insurance program. Previous studies have shown that when Medicare was introduced, more people used health care, and when people entered into Medicare coverage, they had more access to healthcare and had better health (if they didn’t have health insurance before). Other studies have also shown that racial and ethnic disparities in health care access get smaller for those older than 65 years old. So it is known that Medicare can really benefit those who didn’t previously have health insurance. Nationally, it appears that racial and ethnic disparities in access to healthcare are reduced after 65 years old, but the cause of these reductions is not entirely known.

We don’t yet know if the introduction of Medicare for people over 65 years old is what is driving the reduction in racial and ethnic disparities in health outcomes and access to health care. To answer this question, a group of researchers from Yale University, Harvard Medical School, and Massachusetts General Hospital decided to look at publicly available national-level health survey data from the US Centers for Disease Control and Prevention (CDC). The researchers filtered the responses to include only those who were between 51 and 79 years old from 2008-2018 — over 2.4 million respondents. The researchers then compared people who were 51 to 64 years old, and those who were 65 up to age 79, so that the only difference between these two groups would be turning 65, and therefore becoming eligible for Medicare.

Overall, their results found that people were much more likely to have health insurance if they were just over 65 compared to those just under 65 years old. From this, they concluded that Medicare eligibility was associated with increased health insurance coverage. Black respondents and Hispanic respondents had a higher increase in health insurance coverage compared to White respondents. These researchers found a 53% reduction in the gap between White and Black adults in health insurance coverage, and a 51% reduction in the health insurance coverage gap between White and Hispanic adults.

Hispanic adults had higher improvements in access to care compared to White adults. Specifically, there was a 29% reduction in the gap in having a regular source of healthcare, 39% gap reduction among the proportion of people who couldn’t see a doctor because of cost, and 59% reduction in disparity in flu vaccine shots. For these same health care gaps between Black and White adults, there were no statistically significant changes.

In self-reported health, both Hispanic and Black adults showed much higher rates of improvement compared to White adults. In other words, the amount of people who said they were in poor health decreased much more among Hispanic or Black adults compared to White adults. This translated into a 55% reduced disparity gap between Hispanic and White adults and 40% reduction in the proportion of poor self-reported health between Black and White adults.

Overall, this study and these results showed that becoming eligible for Medicare healthcare coverage was associated with reducing the racial and ethnic disparities in health care coverage, access to healthcare, and self-reported health, but did not succeed in entirely eliminating these differences seen by race and ethnicity. The authors suggest that expanding Medicare could be a way to reduce these racial and ethnic disparities in health care coverage and access to healthcare in the United States.

Study Information

Original study: Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at Age 65 Years

Study published on: July 26, 2021

Study author(s): Jacob Wallace, PhD; Karen Jiang, BA; Paul Goldsmith-Pinkham, PhD; Zirui Song, MD, PhD

The study was done at: Yale University, USA; Harvard Medical School, USA; Massachusetts General Hospital, USA

The study was funded by: Tobin Center for Economic Policy at Yale University and a grant from the Office of the Director, National Institutes of Health (DP5-OD024564)

Raw data availability:

Featured image credit: Sciworthy