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Does Medicare Save Lives? *
Open accessAbstract
Health insurance characteristics shift at age 65 as most people become eligible for Medicare. We measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends. The age profiles of admissions and comorbidities for these patients are smooth at age 65, suggesting that the severity of illness is similar on either side of the Medicare threshold. In contrast, the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities, implying that patients over 65 receive more services. We estimate a nearly 1-percentage-point drop in 7-day mortality for patients at age 65, equivalent to a 20% reduction in deaths for this severely ill patient group. The mortality gap persists for at least 9 months after admission.
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“Specifically the period from 1940 to 1955 was also one in which the use of antibiotics in the treatment of infectious disease emerged and grew in clinical medicine”
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“the period 1971 to 1985 saw the growth of Medicare and improvement in the treatment and prevention of life-threatening chronic diseases, especially heart disease.”
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“Card et al. (2008) find no evidence that individuals nearing age 65 postpone inpatient care in significant numbers until they qualify for Medicare, and Long et al. (1998) find little evidence of health care stockpiling for the general population.”
BackgroundMethodResultInfluentialSelf-citationThe Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?
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Short-run effects of job loss on health conditions, health insurance, and health care utilization
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Does Universal Coverage Improve Health? The Massachusetts Experience
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“Using age variation in Medicare coverage to identify its effect, several researchers find, at best, very modest health benefits from Medicare, both at the time of its introduction (Finkelstein and McKnight 2008) and in more recent times (Card, Dobkin, and Maestas 2009).”
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“How can UI have significant consumption smoothing and liquidity benefits but little effect on ex-post wages? Lentz and Tranas (2005), Chetty (2008), and Card et al.”
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“Examples include Behaghel et al. (2008), Card et al. (2008, 2009), Carpenter and Dobkin (2009), Chen and van der Klaauw (2008), De Giorgi (2005), Edmonds (2004), Edmonds et al. (2005), Ferreira (2010), Lalive et al. (2006), Lalive (2007, 2008), Lee and McCrary (2005), Lemieux and Milligan (2008)…”
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“Following Card et al. (2009), we experiment with dropping the discharge records of newborns born within one month from the end of the sample period every year, to preclude length-biased sampling problems.”
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“My approach is motivated by that of Card, Dobkin, and Maestas (2009), who selected a subset of diagnoses that appear to have similar rates of appearance in emergency rooms on weekdays and weekends.”
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“As in Card et al. (2009), I restrict the sample to patients admitted for a " nondeferrable " primary condition, i.e. those with a weekend admissions rate close to 2/7ths.”
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“…the elderly have found mixed results: analysis of the 1965 introduction of Medicare did not find any mortality change (Finkelstein & McKnight, 2008), while a regression discontinuity analysis of more recent data detected a reduction in in-hospital deaths at age 65 (Card, Dobkin, & Maestas, 2009).”
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“In the web appendix, Panel A of Figure W1 shows coefficients on the relevant interaction terms if we run specification (1) cohort”
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“Several studies focus on Medicare or Medicaid (Currie & Gruber, 1996; Finkelstein, 2007; Card, Dobkin, & Maestas, 2008, 2009; Currie, Decker, & Lin, 2008).”
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“Our fuzzy RD design has several advantages over other methods of identification and has been applied to multiple different settings (Edmonds et al. 2005; Card et al. 2009; Miller et al. 2013).”
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Self-citationTeam-Specific Human Capital and Team Performance: Evidence from Doctors
Chen, Y. (2021) · American Economic Review · doi:10.1257/aer.20201238 · Cited by 52
“Studies have shown positive returns to treatment intensity for patients with emergency health conditions (e.g., Card et al. 2009; Doyle 2011; Doyle et al. 2015; Silver 2016).”
BackgroundResultWarner, M., Burn, S. L., Stoye, G., Aylin, P. P., Bottle, A., & Propper, C. (2021) · BMJ Quality & Safety · doi:10.1136/bmjqs-2021-013942 · Cited by 54
Medical Spending and the Health of the Elderly
Hadley, J., Waidmann, T., Zuckerman, S., & Berenson, R. A. (2011) · Health Services Research · doi:10.1111/j.1475-6773.2011.01276.x · Cited by 48
“…Medicare and found that greater medical care use following Medicare coverage improved health (Lichtenberg 2002; McWilliams et al. 2007a, b, 2003; Card, Dobkin, and Maestas 2009), none of these studies is directly relevant to the question of whether variations in medical spending for people…”
BackgroundRellstab, S., Bakx, P., García‐Gómez, P., & van Doorslaer, E. K. A. (2019) · Journal of Health Economics · doi:10.1016/j.jhealeco.2019.102275 · Cited by 47
“Second, we conduct a robustness test using a subset of nondeferrable conditions that occur with the same frequency on weekends as on weekdays (Card et al., 2009; Dobkin et al., 2018) (see Section 5.”
Hospital Avoidance and Unintended Deaths during the COVID-19 Pandemic
Zhang, J. (2021) · American Journal of Health Economics · doi:10.1086/715158 · Cited by 51
“For these sources, there is a lag between actual date of death and the date the VA is notified of 3 Card, Dobkin, and Maestas (2009) and Cabral and Mahoney (2019) classify procedures as urgent based on the relative distribution of case counts occurring on weekdays versus weekends, the idea being…”
BackgroundMedicare Spending for Previously Uninsured Adults
McWilliams, J. M., Meara, E., Zaslavsky, A. M., & Ayanian, J. Z. (2009) · Annals of Internal Medicine · doi:10.7326/0000605-200912010-00149 · Cited by 46
Old age pension and intergenerational living arrangements: a regression discontinuity design
Chen, X. (2015) · Review of Economics of the Household · doi:10.1007/s11150-015-9304-y · Cited by 46
“Such RD design has several advantages over other methods of identification and has been applied to multiple different settings (Edmonds et al. 2005; Card et al. 2009; Miller et al. 2013; Sun and Eggleston 2014).”
Health Insurance and Income Inequality
Kaestner, R. J., & Lubotsky, D. H. (2016) · The Journal of Economic Perspectives · doi:10.1257/jep.30.2.53 · Cited by 48
Citizenship, Fertility, and Parental Investments
Avitabile, C., Clots‐Figueras, I., & Masella, P. (2014) · American Economic Journal Applied Economics · doi:10.1257/app.6.4.35 · Cited by 45
Keng, S., & Wu, S. (2013) · Journal of Happiness Studies · doi:10.1007/s10902-013-9449-4 · Cited by 45
Partners’ leisure time truly together upon retirement
Stancanelli, E., & van Soest, A. (2016) · IZA Journal of Labor Policy · doi:10.1186/s40173-016-0068-7 · Cited by 44
What Does (Formal) Health Insurance Do, and for Whom?
Finkelstein, A. N., Mahoney, N., & Notowidigdo, M. J. (2018) · Annual Review of Economics · doi:10.1146/annurev-economics-080217-053608 · Cited by 44
Metadata
- Authors
- Card, D., Dobkin, C., & Maestas, N.
- Affiliations
- University of California, Berkeley (US)
- University of California, Santa Cruz (US)
- RAND Corporation (US)
- Venue
- Quarterly Journal of Economics
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-05
- Volume
- 124
- Issue
- 2
- Pages
- 597-636
- ISSN
- 0033-5533 (ISSN-L)
- 1531-4650
- PMC
- PMC2777733
- OpenAlex
- W2145644832
- Cited by
- 494
- References
- 40
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 28 · 2023: 29 · 2022: 30 · 2021: 40 · 2020: 33 · 2019: 33 · 2018: 21 · 2017: 37 · 2016: 39 · 2015: 38 · 2014: 36 · 2013: 28 · 2012: 28
- FWCI
- 48.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Quarterly Journal of Economics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Institute on Aging (R01AG026290, R03AG025155)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
- Keywords
- Medicare, health insurance coverage, emergency department admission, hospital discharge, mortality, older adults, comorbidities, hospital procedures, life expectancy
- MeSH terms
- Aged, Medicare, Humans, Middle Aged, Mortality, United States
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