Hames, Alexandra Glynn
(2024)
Health Care Affordability for Adults Aged 60 and Older: The Role of Insurance Benefit Design.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Differences in health insurance coverage and benefit design can affect health care access, use, and affordability, and may exacerbate racial/ethnic disparities. High out-of-pocket costs raise concerns that individuals may defer or forgo necessary care. Chronically ill and aging populations are at risk for poorer health outcomes when delaying or forgoing care, which may result in complications and costly hospitalizations among individuals with chronic conditions such as diabetes.
This dissertation used survey data and health insurance administrative claims to examine dynamics of high deductible health plan (HDHP) enrollment and cost-related barriers to care for older adults aged 60-64 years; evaluated the impact of shifting coverage from HDHPs to private Medicare Advantage (MA) plans at age 65 on out-of-pocket costs and utilization; and explored whether Medicare Advantage helped to narrow racial/ethnic disparities in access to care and utilization compared to traditional Medicare (TM).
In Aim 1, I showed that, among adults aged 60-64, HDHP enrollment was prevalent and associated with greater likelihood of reporting any cost-related barriers to care or problems paying medical bills, high financial burden, and out-of-pocket spending than non-HDHP plans. In Aim 2, I conducted a longitudinal cohort study with a difference-in-differences analysis and found that after enrollment in MA plans at age 65, utilization of outpatient care increased and out-of-pocket costs decreased among older adults with prior enrollment in an HDHP, in comparison to changes among older adults who were previously enrolled in plans with lower deductibles. In Aim 3, I conducted a difference-in-disparities study and found that MA was associated with narrowing of some Black-White and Hispanic-White disparities in cost-related access barriers vs. TM but did not uniformly narrow racial/ethnic disparities in access and use.
Together, results from this dissertation provide evidence to policymakers considering expansions to Medicare or changes to the Medicare Advantage program. Proposals such as lowering age eligibility to 60 could improve financial and health outcomes for older adults in plans with high deductibles. Policymakers should also prioritize maintaining and enhancing features of Medicare coverage that promote equitable access to care, including additional benefits and lower cost-sharing.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
26 June 2024 |
| Date Type: |
Publication |
| Defense Date: |
22 April 2024 |
| Approval Date: |
26 June 2024 |
| Submission Date: |
23 June 2024 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
138 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Health Policy & Management |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Medicare, employer-sponsored insurance, insurance benefit design, health care costs, racial and ethnic disparities, older adults |
| Date Deposited: |
27 Jun 2024 00:54 |
| Last Modified: |
27 Jun 2024 00:54 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46553 |
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