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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”
From Social security and mortality: The role of income support policies and population health in the United States (2011) · cites this paper as [40]
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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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Shigeoka, H. (2012) · SSRN Electronic Journal · doi:10.2139/ssrn.2174740 · Cited by 43
“Indeed, Card, Dobkin, and Maestas (2009) concluded that it is not clear whether reductions in mortality are due to health insurance provision or generosity.”
BackgroundMethodInfluentialDoes prescription drug coverage improve mental health? Evidence from Medicare Part D
Ayyagari, P., & Shane, D. M. (2015) · Journal of Health Economics · doi:10.1016/j.jhealeco.2015.01.006 · Cited by 41
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Externalities and Taxation of Supplemental Insurance: A Study of Medicare and Medigap
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The elderly's response to a patient cost-sharing policy in health insurance: Evidence from China
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Public Healthcare Entitlements and Healthcare Utilisation among the Older Population in Ireland
Ma, Y., & Nolan, A. (2016) · Health Economics · doi:10.1002/hec.3429 · Cited by 38
“Nonetheless, a number of studies examining the older population have found significant effects of insurance/cost-sharing on healthcare utilisation (Card et al., 2008; Card et al., 2009; Chandra et al., 2010; Chen et al., 2007; Shigeoka, 2014; Goldman et al., 2007; Puig-Junoy et al., 2016).”
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“Patients eligible for Medicare receive more intensive care than those just below age 65 years and privately insured, Medicaid insured, or uninsured.(7) In particular, insurance coverage has been shown to be associated with the type of treatment received in patients with acute myocardial infarction (AMI).”
BackgroundDoes Medicare Coverage Improve Cancer Detection and Mortality Outcomes?
Myerson, R. M., Tucker‐Seeley, R. D., Goldman, D. P., & Lakdawalla, D. N. (2019) · Journal of Policy Analysis and Management · doi:10.1002/pam.22199 · Cited by 38
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BackgroundMethodInfluentialHips and hearts: The variation in incentive effects of insurance across hospital procedures
Doiron, D., Fiebig, D. G., & Suziedelyte, A. (2014) · Journal of Health Economics · doi:10.1016/j.jhealeco.2014.06.006 · Cited by 37
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Check up before you check out: Retail clinics and emergency room use
Alexander, D., Currie, J., & Schnell, M. K. (2019) · Journal of Public Economics · doi:10.1016/j.jpubeco.2019.104050 · Cited by 37
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“…thresholds, using a regression discontinuity design—a powerful tool for estimating causal relationships in health policy (Almond and Doyle 2008; Card, Dobkin, and Maestas 2009) —to evaluate whether hospitals with quality scores just above payment thresholds improved quality more in subsequent…”
MethodHealth Insurance Effects on Preventive Care and Health
Wallace, J., & Sommers, B. D. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.01.003 · Cited by 36
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“Card, Dobkin, and Maestas (2009) [15] used a regression discontinuity design to study the effects of Medicare on mortality of inpatients over age 65 in the emergency department within seven days.”
BackgroundMethodThe Economic Consequences of Hospital Admissions
Dobkin, C., Finkelstein, A. N., Kluender, R., & Notowidigdo, M. J. (2016) · National Bureau of Economic Research · doi:10.3386/w22288 · Cited by 37
Self-citationThe Mortality and Medical Costs of Air Pollution: Evidence from Changes in Wind Direction
Deryugina, T., Heutel, G., Miller, N., Molitor, D., & Reif, J. (2016) · National Bureau of Economic Research · doi:10.3386/w22796 · Cited by 37
The Impacts of Physician Payments on Patient Access, Use, and Health
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“NSD combines poverty, unemployment, female-headed families, public assistance households, and proportion of African Americans.”
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Gender differences in health insurance coverage in China
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The Uk Minimum Wage at 22 Years of Age: A Regression Discontinuity Approach
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“For example, Card et al. (2009) examined the effect on health outcomes of Medicare coverage at age 65 years, Lemieux and Milligan (2008) examined the effect of welfare benefit increases at age 30 years and Bargain and Doorley (2011) examined the effect of welfare increases at age 25 years in France…”
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Weaver, M. R., Nandakumar, V., Joffe, J., Barber, R. M., Fullman, N., Singh, A. G., Sparks, G. W., Yearwood, J. A., Lozano, R., Murray, C. J. L., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.14730 · Cited by 34
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The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality
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Health benefits of reduced patient cost sharing in Japan
Nishi, A., McWilliams, J. M., Noguchi, H., Hashimoto, H., Tamiya, N., & Kawachi, I. I. (2012) · Bulletin of the World Health Organization · doi:10.2471/blt.11.095380 · Cited by 32
Life cycle responses to health insurance status
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“In particular, the model reproduces noticeably better health and moderately better survival (Lichtenberg, 2002; Khwaja, 2010; Finkelstein and McKnight, 2008; Card et al., 2009; Scholz and Seshadri, 2012), as well as more investment (Lichtenberg, 2002; Khwaja, 2010; Finkelstein, 2007; Card et al.”
InfluentialMcInerney, M. P., Winecoff, R., Ayyagari, P., Simon, K. I., & Bundorf, M. K. (2020) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/0046958020935229 · Cited by 31
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Black, B., Hollingsworth, A., Nunes, L., & Simon, K. (2022) · Journal of Public Economics · doi:10.1016/j.jpubeco.2022.104713 · Cited by 31
Supply-side health policy: The impact of scope-of-practice laws on mortality
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The effect of predictive analytics-driven interventions on healthcare utilization
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The Impact of Health Insurance on Stockholding: A Regression Discontinuity Approach
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Is There a VA Advantage? Evidence from Dually Eligible Veterans
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Dillender, M. (2015) · Journal of Health Economics · doi:10.1016/j.jhealeco.2015.07.004 · Cited by 30
Healthcare Demand under Simple Prices: Evidence from Tiered Hospital Networks
Prager, E. (2020) · American Economic Journal Applied Economics · doi:10.1257/app.20180422 · Cited by 29
The Impact Of Medicare On Access To And Affordability Of Health Care
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Old Age Risks, Consumption, and Insurance
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Joint Leisure Before and after Retirement: A Double Regression Discontinuity ApproachPreprint
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“…use an instrumental variable approach, namely two stages least squares (see, Jinyong Hahn, Petra Todd and Wilbert van der Klaauw [2001], for proofs; and for example, David Card, Carlos Dobkin, and Nicole Maestas [2009] for an application using also an age discontinuity to identify the treatment).”
MethodSaving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility
Meyer, B., & Wherry, L. (2012) · National Bureau of Economic Research · doi:10.3386/w18309 · Cited by 29
The Impact of the Affordable Care Act: Evidence from California's Hospital Sector
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Environment, Health, and Human Capital
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The Impact of Medicare Health Insurance Coverage on Lung Cancer Screening
Sun, J., Perraillon, M. C., & Myerson, R. M. (2021) · Medical Care · doi:10.1097/mlr.0000000000001655 · Cited by 30
Public healthcare eligibility and the utilisation of GP services by older people in Ireland
Hudson, E. M., & Nolan, A. (2014) · The Journal of the Economics of Ageing · doi:10.1016/j.jeoa.2014.08.005 · Cited by 28
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Do High-Cost Hospitals Deliver Better Care? Evidence from Ambulance Referral Patterns
Doyle, J. J., Graves, J. A., B, J. G. A., & Kleiner, S. A. (2012) · National Bureau of Economic Research · doi:10.3386/w17936 · Cited by 28
“Following Dobkin (2003) and Card et al. (2009), diagnoses whose weekend admission rates are closest to 2/7ths reflect a lack of discretion as to the timing of the hospital admission.”
The Oregon Health Insurance Experiment: Evidence from the First Year
Finkelstein, A. N., Taubman, S. L., Wright, B. J., Mira Bernstein, A., B, J. G. A., Newhouse, J. P., ALLEN, H. L., D, K. B. A., & The Oregon Health Study Group (2011) · National Bureau of Economic Research · doi:10.3386/w17190 · Cited by 28
Does Medicare Reduce Medical Debt?
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Sun, J., & Lyu, S. (2020) · International Journal of Health Services · doi:10.1177/0020731420914824 · Cited by 25
“found that Medicare, a type of health insurance for elderly individuals in the United States, significantly reduced the mortality at 7 days for emergency-admitted patients aged 65.(28) However, some studies have argued that many factors contribute to the improvement of health status and that health insurance could not…”
BackgroundAggarwal, R., Yeh, R. W., Dahabreh, I. J., Robertson, S. E., & Wadhera, R. K. (2022) · PLoS Medicine · doi:10.1371/journal.pmed.1004083 · Cited by 24
“Using data from 1999 to 2003, one prior study found that the onset of Medicare eligibility led to increases in health insurance coverage and utilization, and a subsequent analysis found that Medicare was associated with improved mortality in patients hospitalized for acute conditions [11,41].”
MethodThe Grossman model after 40 years: a reply to Peter Zweifel
Kaestner, R. J. (2012) · The European Journal of Health Economics · doi:10.1007/s10198-012-0451-2 · Cited by 24
Cancer diagnoses and survival rise as 65‐year‐olds become Medicare‐eligible
Patel, D. C., He, H., Berry, M. F., Yang, C. J., Trope, W., Wang, Y. Y., Lui, N. S., Liou, D. Z., Backhus, L. M., & Shrager, J. B. (2021) · Cancer · doi:10.1002/cncr.33498 · Cited by 23
“Furthermore, accurately identifying the proportion of uninsured in the near elderly within large national databases will always be difficult because of the large number of individuals who are transitioning in and out of coverage and the myriad insurance combinations that may exist in this age group.(4,24,30,31) The fi…”
BackgroundBounds on Treatment Effects in Regression Discontinuity Designs with a Manipulated Running Variable
Gérard, F., Rokkanen, M., & Rothe, C. (2016) · National Bureau of Economic Research · doi:10.3386/w22892 · Cited by 23
“…similarities with that of Horowitz and Manski (1995) or Lee (2009); and some applied papers have used heuristic arguments to arrive at some version of this strategy (e.g., Card, Dobkin, and Maestas (2009), Sallee (2011), Anderson and Magruder (2012), Schmieder, von Wachter, and Bender (2012)).”
The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection
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Kwok, J. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4030445 · Cited by 23
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OLD‐AGE PENSION AND EXTENDED FAMILIES: HOW IS ADULT CHILDREN'S INTERNAL MIGRATION AFFECTED?
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“Assuming that children’s migration decision is continuous with respect to the age of the elderly, the RD design, already applied to multiple health policy settings (e.g. Edmonds et al. 2005; Card et al. 2009; Miller et al. 2013; Sun and Eggleston 2014), is able to disentangle the effect of pension receipt from other a…”
MethodThe Impact of Rural Pensions in China on Labor Migration
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Is Employer-Based Health Insurance a Barrier to Entrepreneurship?Preprint
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The impact of childhood experience of starvations on the health of older adults: Evidence from China
Liu, Y., Diao, L., & Xu, L. (2020) · The International Journal of Health Planning and Management · doi:10.1002/hpm.3099 · Cited by 21
A Simple Adjustment for Bandwidth Snooping
Armstrong, T. B., & Kolesár, M. (2017) · The Review of Economic Studies · doi:10.1093/restud/rdx051 · Cited by 21
“For prominent examples see, for instance, van Der Klaauw (2002), Lemieux and Milligan (2008), Ludwig and Miller (2007), or Card et al. (2009).”
Scott, J. W., Neiman, P. U., Tipirneni, R., Fan, Z., & Ayanian, J. Z. (2021) · JAMA Health Forum · doi:10.1001/jamahealthforum.2021.2531 · Cited by 21
Financial Incentives, Hospital Care, and Health Outcomes: Evidence from Fair Pricing Laws
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Anagol, S., & Fujiwara, T. (2014) · National Bureau of Economic Research · doi:10.3386/w20261 · Cited by 21
Using RD design to understand heterogeneity in health insurance crowd-out
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What to expect when you are expecting: Are health care consumers forward-looking?
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“Urgent Procedures Definition 1: Card, Dobkin, & Maestas (2009) and Cabral & Mahoney (2014) Card et al. (2009) classify emergency room ICD-9 diagnosis codes as urgent based on its weekend/weekday frequencies.”
InfluentialTipirneni, R., Levy, H. G., Langa, K. M., McCammon, R. J., Zivin, K., Luster, J. E., Karmakar, M., & Ayanian, J. Z. (2020) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbaa123 · Cited by 20
Unintended effects of reimbursement schedules in mental health care
Douven, R., Remmerswaal, M., & Mosca, I. (2015) · Journal of Health Economics · doi:10.1016/j.jhealeco.2015.03.008 · Cited by 20
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Do Higher-Priced Hospitals Deliver Higher-Quality Care?
Cooper, Z., Doyle, J. J., Graves, J., & B, J. G. A. (2022) · National Bureau of Economic Research · doi:10.3386/w29809 · Cited by 20
The Impact of Health Insurance on Mortality
Levy, H. G., & Buchmueller, T. C. (2025) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-061022-042335 · Cited by 21
Improving Older Adults’ Health by Reducing Administrative Burden
HERD, P. (2023) · The Milbank Quarterly · doi:10.1111/1468-0009.12629 · Cited by 19
The effects of global budget payments on hospital utilization in rural Maryland
Done, N., Herring, B. J., & Xu, T. (2019) · Health Services Research · doi:10.1111/1475-6773.13162 · Cited by 19
Does Medicare Part D Save Lives?
Dunn, A. C., & Shapiro, A. H. (2017) · American Journal of Health Economics · doi:10.1162/ajhe_a_00107 · Cited by 21
“Notes: This tables shows the estimates of τd in equation (6) under 24 different specifications.”
InfluentialThe Effects of Medicare on Health-Care Utilization and Spending Among the Elderly
Chatterji, P., Nguyen, T. T., & Yörük, B. K. (2021) · American Journal of Health Economics · doi:10.1086/716544 · Cited by 20
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Reductions in out-of-pocket prices and forward-looking moral hazard in health care demand
Johansson, N., de New, S. C., Kunz, J., Petrie, D., & Svensson, M. (2022) · Journal of Health Economics · doi:10.1016/j.jhealeco.2022.102710 · Cited by 18
The Impact of Insurance on HIV Testing
Sood, N., Wagner, Z., & Wu, Y. (2015) · American Journal of Health Economics · doi:10.1162/ajhe_a_00028 · Cited by 18
“It is well understood that lack of health insurance can affect health status of the HIV positive by reducing access to treatment, especially new and expensive treatments (Bhattacharya, Goldman, and Sood 2003; Card, Dobkin, and Maestas 2008, 2009).”
BackgroundBanks, J. W., Blundell, R. W., Levell, P., & Smith, J. P. (2019) · American Economic Journal Economic Policy · doi:10.1257/pol.20170182 · Cited by 18
“Around 12 percent of the population is already enrolled by the time they reach age 65 (Card, Dobkin, and Maestas 2009).”
BackgroundThe impact of medical insurance programmes on the health of the insured: Evidence from China
Meng, Y.-Y., Zhang, X., & Han, J. (2019) · The International Journal of Health Planning and Management · doi:10.1002/hpm.2931 · Cited by 18
Medicaid, family spending, and the financial implications of crowd-out
Dillender, M. (2017) · Journal of Health Economics · doi:10.1016/j.jhealeco.2017.02.002 · Cited by 18
Defensive Medicine: Evidence from Military Immunity
Frakes, M., & B, J. G. A. (2018) · National Bureau of Economic Research · doi:10.3386/w24846 · Cited by 18
Guthmuller, S., & Wittwer, J. (2017) · Health Economics · doi:10.1002/hec.3464 · Cited by 17
“Some papers estimate the effect of Medicare coverage on mortality and healthcare utilisation using age as an assignment variable (Card et al., 2008; Card et al., 2009).”
BackgroundHospital treatment and patient outcomes: Evidence from capacity constraints
Kleiner, S. A. (2019) · Journal of Public Economics · doi:10.1016/j.jpubeco.2019.03.011 · Cited by 17
Do minimum wage increases benefit worker health? Evidence from China
Chen, J. (2020) · Review of Economics of the Household · doi:10.1007/s11150-020-09500-3 · Cited by 17
The Impact of the Affordable Care Act: Evidence from California’s Hospital Sector
Duggan, M., Gupta, A., & Jackson, E. (2022) · American Economic Journal Economic Policy · doi:10.1257/pol.20190279 · Cited by 17
Hu, T., Decker, S. L., & Chou, S. (2017) · International Journal of Health Economics and Management · doi:10.1007/s10754-017-9211-2 · Cited by 16
“Since the identification comes from the comparison around the age threshold, estimation can be done using only data from after policy adoption (Card et al. 2009).”
HEALTH, HEALTH INSURANCE, AND INEQUALITY
Chen, C., Feng, Z., & Gu, J. (2024) · International Economic Review · doi:10.1111/iere.12722 · Cited by 16
Bhat, A. C., Fenelon, A. T., & Almeida, D. M. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1485371 · Cited by 16
“Older adults at retirement age are eligible to receive and access affordable housing programs (M1a in Figure 1) and government benefits (e.g., Social Security benefits and Medicare/Medicaid ; M1b and M1c in Figure 1) (26, 152, 153).”
Prenovitz, S. J. (2020) · Health Economics · doi:10.1002/hec.4203 · Cited by 15
Effect of new Medicare enrollment on health, healthcare utilization, and cost: A scoping review
Yeung, K., Dorsey, C. N., & Mettert, K. D. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17113 · Cited by 15
“The Medicare transition was associated with reduced mortality among patients hospitalized for severe conditions.(11) Compared to the previously insured, the previously uninsured have relative improvements in overall health,(12,13) and physical and mental function.”
BackgroundInfluentialChen, C., Liu, G. G., Wang, T., & Tan, J. (2023) · Health Economics · doi:10.1002/hec.4738 · Cited by 16
Pisc, J. A., Ting, A., Skornicki, M., Sinno, O., & Lee, E. W. (2023) · Journal of Comparative Effectiveness Research · doi:10.57264/cer-2023-0108 · Cited by 15
“Eligibility for Medicare insurance is determined by age [18] , while Medicaid eligibility is primarily focused on low income families and individuals but varies by US state [19] .”
Background
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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