Medicare and Disparities in Women's Health
Sandra Decker, Carol Rapaport
NBER Working Paper No. 8761
We investigate the effect of universal health insurance on health outcome and the use of health services by exploiting a natural experiment that changes the insurance status of most Americans at age 65; that is, eligibility for the U.S. Medicare program. We compare inequalities in health and health care use just before and after the age of universal Medicare coverage (65) in the United States. We focus in this paper on the use of services related to breast cancer. We test whether Medicare improves the use of early detection services and ultimately stage of diagnosis of breast cancer particularly for groups shown to be more likely to be uninsured prior to age 65, such as black women or women with less than a high school education. Our results show that education differences in mammography and breast exam receipt and ultimately in stage of diagnosis of breast cancer lessen after the age of 65 for white women. We also find that turning 65 significantly increases the chance that a black woman, especially a less educated black woman, has had a mammogram. We do not find comparable evidence that stage of diagnosis is improved for black women after the age of 65.