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NEWS ALERT
Harvard Medical School Office of Public Affairs
HEALTH COVERAGE IMPROVES HEALTH AND REDUCES MAJOR HEART COMPLICATIONS
FINDINGS:
A 12-year study of over 7,000 Americans shows that individuals without health insurance experience a dramatic improvement in their subsequent health trends when they become eligible for Medicare at age 65.
RELEVANCE:
In an era when health-care coverage is a very prominent issue on the political landscape, this study provides the most rigorous assessment to date of the impact of insurance on health.
Dr. John Ayanian
A new study in the December 26 issue of the Journal of the American Medical Association, JAMA, provides the most comprehensive evidence to date that expanding coverage to people without it leads to demonstrable improvements in health.
“This study provides strong evidence about how health improves when people gain insurance coverage,” says Dr. John Ayanian, senior author and Professor of Health Care Policy and Medicine at Harvard Medical School and Brigham and Women’s Hospital. “For every 100 uninsured people with heart disease or diabetes before age 65, we found that with Medicare coverage they had 10 fewer major cardiac complications, such as heart attacks or heart failure, than expected by age 72,” he adds.
The study was funded by The Commonwealth Fund.
In order to provide a macro-view on the health effects of gaining insurance coverage, Ayanian, lead author Dr. J. Michael McWilliams, a research associate in Harvard Medical School’s Department of Health Care Policy and Brigham and Women’s Hospital, and Harvard colleagues assessed data from the Health and Retirement Study, an ongoing longitudinal survey of aging Americans sponsored by the National Institute on Aging.
The researchers analyzed survey data collected from 7,233 participants every two years from 1992 through 2004, and examined their health from age 55 to 72. Among these individuals, 5,006 were continuously insured, while 2,227 were either persistently or intermittently uninsured until they qualified for Medicare at age 65.
“While it may seem self-evident that gaining health insurance should improve health, some experts have questioned this assumption,” says McWilliams. “By comparing the health trends of insured and uninsured adults as they became eligible for Medicare, we were able to measure the impact of coverage on health in a more rigorous way.”
During this 12-year period, participants were asked to comprehensively report their health across a series of dimensions, including overall health, physical functioning (such as ability to climb stairs or walk certain distances), bodily pain, depression, and cardiovascular outcomes including heart attacks or strokes.
Individuals with continuous coverage did not report a significant change in their health as they transitioned to Medicare, but those who had little or no prior coverage reported substantial improvements in their health trends. The impact of coverage was greatest for those with a history of heart disease, stroke, high blood pressure, or diabetes. Participants with these conditions who lacked insurance experienced a steeper decline in health compared to their insured counterparts prior to age 65. But after five years of Medicare coverage this health gap closed by 50 percent.
“Forty-seven million people are currently without health insurance in the United States,” said Sara Collins, Ph.D., assistant vice president at the Commonwealth Fund. “The findings of this study underscore the urgency of health reform efforts to provide health insurance to the full population.”
These findings build upon an earlier study by the same authors last July, also funded by the Commonwealth Fund. In that paper, published in the New England Journal of Medicine, the authors showed that uninsured adults transitioning to Medicare end up costing the system more in annual medical spending after 65 compared with continuously insured individuals.
“Together, the two studies suggest that expanding health coverage is less costly than previously believed and slows declines in health as well,” says Ayanian.
CITATION:
Journal of the American Medical Association, JAMA
December 26, 2007, Vol. 298 No. 23
“Health of Previously Uninsured Adults
After Acquiring Medicare Coverage”
J. Michael McWilliams(1, 2), Ellen Meara(1), Alan M. Zaslavsky(1), John
Z. Ayanian(1,2)
CONTACTS:
David Cameron (Harvard Medical School)
public_affairs@hms.harvard.edu
617.432.0442
Mary Mahon (The Commonwealth Fund)
mm@cmwf.org
212.606.3853
Harvard Medical School has more than 7,500 full-time faculty working in 11 academic departments located at the School's Boston campus or in one of 47 hospital-based clinical departments at 17 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.
The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.