Research Roundup: Raising Medicare's eligibility age; Insurance status affects ER imaging services

Jan 13 2012

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Congressional Budget Office Director's blog: Raising The Ages Of Eligibility For Medicare And Social Security -- The authors analyzed a scenario in which the eligibility age - current 65 - would be increased by two months every year until it reached 67 in 2027. They found that would cut Medicare expenditures by 5 percent but many people between the ages of 65 and 67 would pay more for health care. "CBO expects that most people affected by the change would obtain health insurance from other sources, primarily employers or other government programs, although some would have no health insurance. Federal spending on those other programs would increase, partially offsetting the Medicare savings. Many of the people who would otherwise have enrolled in Medicare would face higher premiums for health insurance, higher out-of-pocket costs for health care, or both" (Meyerson and Manchester, 1/10).

National Bureau Of Economic Research: Does Retiree Health Insurance Encourage Early Retirement?
The health law, the researchers write, "will considerably weaken the link between employment and health insurance by making group coverage available to all individuals regardless of employment." By investigating employee-level data from 64 different companies which are clients of Towers Watson, researchers determined that "retiree health coverage has its strongest effects at ages 62 and 63 resulting in a 3.7 percentage point (21.2 percent) increase in the probability of turnover at age 62 and a 5.1 percentage point (32.2 percent) increase in the probability of turnover at age 63" (Nyce et. al., December 2011).

Journal Of The American College Of Radiology: Imaging And Insurance: Do The Uninsured Get Less Imaging In Emergency Departments? – Using data from the 2004 National Hospital Ambulatory Medical Care Survey, researchers compared treatment among patients who were uninsured, those covered by Medicaid and those with other types of insurance and found that the uninsured patients received 8 percent fewer imaging tests than patients with non-Medicaid insurance and that Medicaid enrollees received 10 percent fewer than those with other insurance. They conclude: "Further research is needed to understand whether insured patients receive unnecessary imaging or if uninsured and Medicaid patients receive too little imaging" (Moser and Applegate, January 2012).

Archives Of Pediatrics And Adolescent Medicine: The Interplay Of Outpatient Services And Psychiatric Hospitalization Among Medicaid-Enrolled Children With Autism Spectrum Disorders -- For children with Austism Spectrum Disorders (ASD), barriers to care -- such as lack of qualified practitioners and poor insurance coverage -- increase the chances that they will be hospitalized for psychiatric reasons. The researchers looked at a large national sample of Medicaid-covered children with ASD to see if "increasing outpatient services results in reduced use of costly and restrictive service." The researchers found that each $1,000 increase in spending on outpatient services like respite care over 60 days "resulted in an 8% decrease in the odds of hospitalization" (Mandell et. al., 1/2)

New England Journal Of Medicine:  Fitness Memberships And Favorable Selection In Medicare Advantage Plans -- Researchers used national figures from the Centers for Medicare and Medicaid Services to see what kind of changes occurred when 11 Medicare Advantage plans incorporated a gym membership as a part of their covered benefits: "Persons enrolling in plans after the addition of a fitness-membership benefit reported significantly better general health, fewer limitations in moderate activities, less difficulty walking." The authors noted that creating an insurance risk pool for Medicare Advantage plans, as well as  for small business and individual plans, violates the 2010 health law. However, a benefits package that caters to a healthier subset of seniors may have the same effect as creating a risk pool (Cooper and Trivedi, 1/11).

Related, from KHN: Gym Memberships In Medicare Advantage Plans Cater To Healthy Seniors (Kulkarni, 1/11) 

Archives Of Ophthamology: The Cost-Effectiveness Of Welcome To Medicare Visual Acuity Screening And A Possible Alternative Welcome To Medicare Eye Evaluation Among Persons Without Diagnosed Diabetes Mellitus -- Medicare currently offers new beneficiaries the opportunity for a visual acuity screening, which is generally done by a primary care professional using eye charts. The researchers looked at simulated data to see if eye care professionals conducting dilated eye evaluations would find more vision problems, provide better treatments and save the patients and the government money over time compared to no screening at all. They found that for asymptomic patients with no diabetes, there is "little evidence that the current policy of visual acuity screening" is cost-effective but "dilated eye examinations at Medicare entry are likely to be cost-effective" (Rein et al., 1/9).