The Medicare program provides nearly universal health insurance coverage for the elderly. The onset of Medicare eligibility is associated with a drop in inter-group disparities in access to ambulatory care and a rise in hospital admission rates. Surprisingly, however, African Americans experience much smaller increases than whites in rates of hospitalization at age 65, and in rates for specific procedures including hip and knee replacements. Thus, Medicare appears to have an ambiguous effect on disparities in healthcare use. We propose a series of projects to study the changes in health care utilization and health that occur as individuals reach the age of Medicare eligibility, and analyze the effects of these changes on the extent of racial and ethnic disparities in health utilization and health. Specifically, we propose to: 1. Analyze the changes in rates of inpatient admissions and outpatient procedures occurring at age 65 for Hispanics, blacks, and whites across major health conditions, and document how the relative changes across groups vary with the nature of the condition and with the characteristics of patients, providers, and institutions. 2. Estimate whether the intensity of hospital treatment varies with eligibility for Medicare, whether these differences affect mortality, and whether the changes in intensity of treatment are different for different ethnic/racial groups. 3. Use panel data sets to estimate the impacts of reaching age 65 on alternative measures of health, physical functioning, and quality of life for Hispanics, blacks and whites. 4. Examine differences across groups in the utilization of health care services in the first few years of Medicare coverage, and test alternative explanations for these differences, including the role of supplemental insurance coverage. ? ? ? ?
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