The Association Between Medicare Eligibility on Elective Procedures and Hospital Transfers: A regression discontinuity design applied to the National Inpatient Sample

Abstract

AbstractIntroductionAccess to affordable health coverage for individuals aged 51 and older, particularly those transitioning out of employer-sponsored insurance or with existing health conditions, is challenging in the United States. This study investigates the potential impact of lowering the Medicare eligibility age on healthcare utilization, focusing on elective procedures among late middle-aged individuals. Previous studies indicate significant increases in healthcare utilization around the Medicare eligibility threshold, but a national-level analysis is needed to understand the implications of policy changes in Medicare eligibility.MethodsThis retrospective cohort study utilized 2019 data from the National Inpatient Sample (NIS), encompassing over seven million hospital stays and covering more than 97% of the U.S. population. We compared two groups: uninsured patients aged 63-64 and Medicare-insured patients aged 65-66. The analysis focused on nine common elective surgical procedures, employing a regression discontinuity design to minimize confounding. Patients were exactly matched on several variables, including reason for hospitalization, sex, race, and hospitalization type (elective vs. emergent).ResultsThe matched cohort, after exact matching, included 70,916 admissions (47,262 from Medicare patients aged 65-66 and 23,654 from uninsured patients aged 63-64). The study found significantly higher utilization rates of elective procedures, including cataract surgery, glaucoma surgery, joint replacement, and spinal fusion, among the Medicare-eligible group compared to the younger, uninsured group. Rates of elective procedures approximately doubled post-eligibility for Medicare. Additionally, being below the Medicare eligibility age was associated with decreased odds of undergoing these procedures and increased odds of hospital transfers.DiscussionLowering the Medicare eligibility age could lead to increased access to elective medical procedures for late middle-aged individuals, potentially reducing delays in treatment and associated complications.