The Dynamic Effects of Poverty and Health Insurance Status On Health Service Utilization Among Older Adults
Methods: This investigation uses data from the Rand version of the Health and Retirement Study spanning the years 2002-2008 to estimate a discrete-time hazard model of health service utilization among older adults. The study draws 60- and 61-year olds from Waves 6 (2002), 7 (2004), 8 (2006), and 9 (2008) and follows their trajectory to explain the dynamic effects of poverty and health insurance status on the utilization decision. The study incorporates both contemporaneous poverty and lagged poverty variables to distinguish the effects of persistent poverty from those of recent falls into poverty. Similarly, the study also utilizes both contemporaneous health insurance status and lagged health insurance status variables to distinguish the effects of persistent health insurance coverage from those of recent coverage.
Results: Life table analysis reveals that poor older adults are much more likely to utilize overnight hospital services and much less likely to utilize doctor services relative to non-poor adults. Moreover, a discrete-time hazard model reveals that poverty status interacts with Medicaid receipt to significantly influence both hospital and doctor service utilization.
Conclusions and Implications: While the recent changes in the Affordable Care Act of 2010 may render public health insurance more readily available for low income individuals, it is not at all clear whether this expansion of the public system will translate into greater health service use, let alone, greater health among affected persons. Nevertheless, the results indicate that advocacy efforts should be directed not necessarily towards expansion of public coverage to near-eligible individuals but towards increasing Medicaid take-up among already eligible individuals.