Working Paper: NBER ID: w8761
Authors: Sandra L. Decker; Carol Rapaport
Abstract: We investigate the effect of universal health insurance on health outcome and the use of health services by exploiting a natural experiment that changes the insurance status of most Americans at age 65; that is, eligibility for the U.S. Medicare program. We compare inequalities in health and health care use just before and after the age of universal Medicare coverage (65) in the United States. We focus in this paper on the use of services related to breast cancer. We test whether Medicare improves the use of early detection services and ultimately stage of diagnosis of breast cancer particularly for groups shown to be more likely to be uninsured prior to age 65, such as black women or women with less than a high school education. Our results show that education differences in mammography and breast exam receipt and ultimately in stage of diagnosis of breast cancer lessen after the age of 65 for white women. We also find that turning 65 significantly increases the chance that a black woman, especially a less educated black woman, has had a mammogram. We do not find comparable evidence that stage of diagnosis is improved for black women after the age of 65.
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Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Medicare eligibility at age 65 (I13) | utilization of early detection services for breast cancer (I19) |
| Medicare eligibility at age 65 (I13) | education differences in mammography and breast exam receipt (I24) |
| Medicare eligibility at age 65 (I13) | likelihood of black women with less education having had a mammogram (I24) |
| Medicare eligibility at age 65 (I13) | stage of diagnosis for black women (J16) |