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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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“Medicare eligibility has been shown to provide many health benefits [14, 15].”
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“Thus there is a discontinuity in access to health insurance at age 65 such that health care usage is expected to rise, especially if individuals were previously uninsured (see, for example, Card et al., 2008, 2009).”
BackgroundKoch, T. G. (2015) · The Journal of Human Resources · doi:10.3368/jhr.50.4.959 · Cited by 15
Health Care Reform in the United States
Carey, D., Herring, B. J., & Lenain, P. (2009) · OECD Economics Department working papers · doi:10.1787/227104360465 · Cited by 15
“Comparing hospital admissions for “nondeferrable” conditions on either side of the Medicare qualification threshold, Card et al. (2007) found that those who were just over the threshold (and therefore almost all insured) enjoyed significantly more treatment and a 20% reduction in the 7-day…”
BackgroundExternalities and Taxation of Supplemental Insurance: A Study of Medicare and Medigap
Cabral, M., & Mahoney, N. (2014) · National Bureau of Economic Research · doi:10.3386/w19787 · Cited by 15
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“3 In contrast to these results, Card, Dobkin, and Maestas (2009) demonstrate that at age 65, insurance rates increase dramatically because of the Medicare program.”
ResultThe Impact of Medicare Coverage on Downstream Financial Outcomes for Adults Who Undergo Surgery
Neiman, P. U., Mouli, V. H., Taylor, K. K., Ayanian, J. Z., Dimick, J. B., & Scott, J. W. (2021) · Annals of Surgery · doi:10.1097/sla.0000000000005272 · Cited by 14
“In accordance with previously published RD analyses, we chose a second-order polynomial design.(18,19) In the NHIS and MEPS, respondent age is determined on December 31 of the survey year and thus an individual who turned 65 during the year of the survey would not be representative of someone who was Medicare eligible…”
MethodResultChen, C. J., & Savva, N. (2018) · SSRN Electronic Journal · doi:10.2139/ssrn.3236983 · Cited by 14
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Health Care for Older Persons in England and the United States: A Contrast of Systems and Values
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“These non-deferrable conditions correspond to admitting diagnoses (ICD-9-CM) with similar admission rates through the ED on weekdays and weekends (Card et al., 2009).”
BackgroundEffects of the Colorectal Cancer Control Program
Bitler, M., Carpenter, C. S., & Horn, D. (2021) · Health Economics · doi:10.1002/hec.4397 · Cited by 12
“As the newly insured individuals at age 65 are disproportionately from low socioeconomic status groups (Card et al. 2008, 2009), these results are particularly relevant for our study of uninsured 50–64-year-olds.”
ResultThe impact of regional sports industry aggregation on residents’ health level in China
Luo, M., & Chen, L. (2024) · Scientific Reports · doi:10.1038/s41598-024-60564-y · Cited by 13
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“In fact, a recent quasi-experimental study has demonstrated a robust link between age eligibility for Medicare and improved survival for acutely ill hospitalized patients (Card et al. 2009).”
BackgroundInfluentialNew Evidence on Welfare’s Disincentive for the Youth Using Administrative Panel Data
Bargain, O., & Jonassen, A. B. (2022) · The Review of Economics and Statistics · doi:10.1162/rest_a_01191 · Cited by 11
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“I also examine the effect of exit on inpatient admissions for the top 40 diagnoses, ordered by the share of admissions that happen on weekends, which is a measure of patients’ willingness to defer treatment (Card et al. 2009).”
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The Effect Of The Affordable Care Act On Cancer Detection Among The Near-Elderly
Duarte, F., Kadiyala, S., Kominski, G. F., & Riveros, A. (2021) · Health Affairs · doi:10.1377/hlthaff.2020.00369 · Cited by 10
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Singleton, P. D. (2022) · Applied Economic Perspectives and Policy · doi:10.1002/aepp.13312 · Cited by 10
“The deviation in food 7 A similar interpretation is necessary in studies that use age eligibility cutoffs for identification; for example, Card, Dobkin, and Maestas (2009), Carpenter and Dobkin (2009), and Fitzpatrick and Moore (2018). insecurity from the extrapolated trend after the EEA is…”
BackgroundSupplier-Induced Demand for Newborn Treatment: Evidence from JapanPreprint
Shigeoka, H., & Fushimi, K. (2012) · SSRN Electronic Journal · doi:10.2139/ssrn.2174758 · Cited by 10
Medicaid Insurance in Old AgePreprint
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“Around 12% of the population are already enrolled by the time they reach age 65 (Card et al. (2009)).”
How did unmet care needs during the pandemic affect health outcomes of older European individuals?
Bergeot, J., & Jusot, F. (2023) · Economics & Human Biology · doi:10.1016/j.ehb.2023.101317 · Cited by 9
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“Studies that concentrate on non-impoverished populations explore the impacts of health insurance on Medicare beneficiaries (Card et al., 2009; Chay et al., 2010), patients with specific diseases like end-stage renal disease (Swaminathan et al., 2018) or cardiovascular disease (Khatana et al.,…”
BackgroundMedical bill shock and imperfect moral hazard
Anderson, D. M., Hoagland, A., & Zhu, E. (2024) · Journal of Public Economics · doi:10.1016/j.jpubeco.2024.105152 · Cited by 9
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Health Insurance and Retirement DecisionsPreprint
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The Impact of Tort Reform on Intensity of Treatment: Evidence from the Heart PatientsPreprint
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Hullegie, P., & Klein, T. J. (2010) · SSRN Electronic Journal · doi:10.2139/ssrn.1653271 · Cited by 9
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Lenhart, O. (2017) · SSRN Electronic Journal · doi:10.2139/ssrn.2969140 · Cited by 9
Managers and Public Hospital Performance
Muñoz, P., & Otero, C. (2025) · American Economic Review · doi:10.1257/aer.20240615 · Cited by 8
Improved survival for individuals with common chronic conditions in the Medicare population
Goldman, D. P., Cohen, B. G., Ho, J. Y., McFadden, D. L., Ryan, M. S., & Tysinger, B. (2020) · Health Economics · doi:10.1002/hec.4168 · Cited by 8
Does demand for health services depend on cost-sharing? Evidence from Italy
Ponzo, M., & Scoppa, V. (2021) · Economic Modelling · doi:10.1016/j.econmod.2021.105599 · Cited by 8
The “Medicare effect” on head and neck cancer diagnosis and survival
Smith, J. B., Jayanth, P., Hong, S. A., Simpson, M. C., & Massa, S. T. (2023) · Head & Neck · doi:10.1002/hed.27379 · Cited by 8
“However, coverage is a dynamic variable for many individuals.(5,31,32) This study assumes patient with HNC diagnosed at nearelderly age are similar to age 65 except for their Medicare eligibility.”
BackgroundThe Interplay of Wealth, Retirement Decisions, Policy and Economic ShocksPreprint
Scholz, J. K., & Seshadri, A. (2012) · SSRN Electronic Journal · doi:10.2139/ssrn.2188373 · Cited by 8
The Effect of Superstition on Health: Evidence from the Taiwanese Ghost Month
Halla, M., Liu, C., & Liu, J. (2019) · National Bureau of Economic Research · doi:10.3386/w25474 · Cited by 8
“To approximate the deferability of an admission, we follow a procedure suggested by Card et al. (2009).”
BackgroundMethodInfluentialDoes the Marginal Hospitalization Save Lives? The Case of Respiratory Admissions for the Elderly
Currie, J. L., & Slusky, D. (2020) · National Bureau of Economic Research · doi:10.3386/w26618 · Cited by 8
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Zwack, C. C., Haghani, M., & de Bekker-Grob, E. W. (2024) · Health Economics Review · doi:10.1186/s13561-023-00471-6 · Cited by 13
Insurance Subsidies, the Affordable Care Act, and Financial Stability
Dodini, S. (2022) · Journal of Policy Analysis and Management · doi:10.1002/pam.22418 · Cited by 8
Quasi-Experimental Design for Health Policy Research: A Methodology Overview
Fahmy, J. N., Cichocki, M. N., & Chung, K. C. (2022) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000009974 · Cited by 7
Can Health Insurance Coverage Improve Educational Attainment? Evidence from China
Zou, W., & Cheng, B. (2022) · International Review of Economics & Finance · doi:10.1016/j.iref.2023.02.011 · Cited by 7
Sieleunou, I., & Betsi, E. (2015) · Journal of Community Medicine & Health Education · doi:10.4172/2161-0711.1000383 · Cited by 7
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“Card et al. (2009) exploit the automatic Medicare (US public health insurance for the elderly) enrollment rules at age 65 in a sharp RD design.”
BackgroundEstimating the monetary benefits of medicare eligibility for reducing the symptoms of dementia
Brent, R. J. (2018) · Applied Economics · doi:10.1080/00036846.2018.1489519 · Cited by 8
“In this regard, a recent set of studies by Card, Dobkin, and Maestas (2008, 2009) is important as it used a Regression Discontinuity (RD) approach to estimate the causal impact of Medicare for improving healthcare outcomes.”
MethodGuthmuller, S., & Wittwer, J. (2012) · Économie publique/Public economics · doi:10.4000/economiepublique.8889 · Cited by 7
Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?
Lucas, A., & Wilson, N. L. (2017) · American Journal of Health Economics · doi:10.1162/ajhe_a_00105 · Cited by 8
Kim, N., & Kawachi, I. I. (2020) · Scientific Reports · doi:10.1038/s41598-020-68189-7 · Cited by 7
Spouses' Retirement and Hours of Work Outcomes : Evidence from Twofold Regression DiscontinuityPreprint
Stancanelli, E. (2012) · RePEc: Research Papers in Economics · Cited by 7
Does Medical Malpractice Law Improve Health Care Quality?Preprint
Frakes, M., & Jena, A. B. (2014) · SSRN Electronic Journal · doi:10.2139/ssrn.2374599 · Cited by 7
The Intended and Unintended Consequences of the Hospital Readmission Reduction ProgramPreprint
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“I add baseline covariates to equations (8) through (10) and show that this does not impact the estimates in magnitude, but increases efficiency.”
BackgroundResultInfluentialThe Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity AnalysisPreprint
Chakrabarti, R., Meyerson, L., Nober, W., & Pinkovskiy, M. L. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3733129 · Cited by 7
“On the other hand, Card et al. (2009) find that individuals admitted to a hospital right after turning 65 (and qualifying for Medicare) are less likely to require readmission and more likely to survive than individuals admitted just before they turn 65.”
BackgroundHealth Care Utilization and Costs for Older Adults Aging Into Medicare After the Affordable Care Act
Tipirneni, R., Roberts, E. T., Levy, H. G., Stefanescu, A. R., Langa, K. M., Zivin, K., Maust, D. T., & Ayanian, J. Z. (2025) · JAMA Health Forum · doi:10.1001/jamahealthforum.2024.5025 · Cited by 6
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“As we all know, URRBMI can effectively reduce the medical expenditures, and increase the probability that rural older adult have access to higher-quality medical services which prompts the physical health of the rural older adult (62).”
BackgroundOrsini, C. (2019) · Health Economics · doi:10.1002/hec.3896 · Cited by 6
“…some studies, the estimates are null or very small (Finkelstein and McKnight, 2008; Kaestner et al., 2014), recent estimates of the impact of Medicare Part D on elderly mortality are around 2.2 percent (Huh and Reif, 2017), and other estimates are larger (Card et al., 2009; Sommers et al., 2014).”
InfluentialPlotsker, E. L., Graziano, F. D., Kim, M., Boe, L. A., Tadros, A. B., Matros, E., Azoury, S. C., & Nelson, J. A. (2024) · Journal of Reconstructive Microsurgery · doi:10.1055/a-2277-0236 · Cited by 6
“37 Given that Medicare services ’ patients aged 65 or older or those with certain comorbidities, 38 it is logical that these patients would have a lower PWBC.”
BackgroundYan, S., Lin, L., & Hu, Y. (2020) · Mathematical Problems in Engineering · doi:10.1155/2020/4020752 · Cited by 6
Identifying the Health Production Function: The Case of Hospitals
Romley, J. A., & Sood, N. (2013) · National Bureau of Economic Research · doi:10.3386/w19490 · Cited by 6
“The elasticity of 30-day mortality with respect to care intensity increases in magnitude from -0.27 to -0.71 for pneumonia and from -0.16 to -0.33 for congestive heart failure, when we address the identification problem.”
BackgroundInfluentialBlack, B. S., Hollingsworth, A. J., Nunes, L., & Simon, K. I. (2019) · SSRN Electronic Journal · doi:10.2139/ssrn.3368187 · Cited by 6
“(2015) and Croke et al. (2016) create synthetic data that is designed to proxy for real world variables of interest.”
BackgroundSloan, F. A. (2020) · National Bureau of Economic Research · doi:10.3386/w26779 · Cited by 6
Villamizar‐Villegas, M., Pinzon‐Puerto, F. A., & Ruiz-Sánchez, M. A. (2020) · doi:10.32468/be.1112 · Cited by 6
The Corporatization of Independent Hospitals
Andreyeva, E., Gupta, A., Ishitani, C., Sylwestrzak, M., & Ukert, B. D. (2023) · National Bureau of Economic Research · doi:10.3386/w31776 · Cited by 6
Uncovering Waste in U.S. Healthcare
Doyle, J. J., Graves, J. A., & B, J. G. A. (2015) · Journal of Health Economics · doi:10.1016/j.jhealeco.2017.03.005 · Cited by 5
Kim, H. (2019) · Social Science Quarterly · doi:10.1111/ssqu.12720 · Cited by 5
Still in Mortal Peril? Recent Research Suggests a New Agenda for Health Care Reform
Malani, A. (2021) · The Journal of Legal Studies · doi:10.1086/708094 · Cited by 5
Yörük, B. K. (2022) · Journal of Economic Behavior & Organization · doi:10.1016/j.jebo.2022.11.006 · Cited by 5
The Value of Medicare Coverage on Depressive Symptoms Among Older Immigrants
Jun, H., Mattke, S., Chen, A. J., & Aguila, E. (2023) · The Gerontologist · doi:10.1093/geront/gnad070 · Cited by 5
Yuan, X., Yang, X., & Zhou, X. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1576146 · Cited by 5
“Studies on Medicare in the United States found that broader coverage improved health and reduced mortality among older adults by 8% (27), while also boosting labor supply (28, 29).”
The Effect of Medicaid on Health Care Consumption of Young Adults
Coey, D. (2014) · Health Economics · doi:10.1002/hec.3042 · Cited by 5
“5Card et al. (2008) and Card et al. (2009) also study the effect of age-related discontinuities in program eligibility on health care use, but for Medicare rather than Medicaid.”
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Glied, S. (2021) · JAMA Health Forum · doi:10.1001/jamahealthforum.2021.4335 · Cited by 6
Health insurance coverage and marriage behavior: Is there evidence of marriage lock?
Chen, T. (2023) · International Studies of Economics · doi:10.1002/ise3.45 · Cited by 5
“The Difference of the First (8) (9) (10) (11) (12) (13) (14)”
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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