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Medicare Eligibility and Physician Utilization Among Adults With Coronary Heart Disease and Stroke

Dugan, Jerome MA*; Virani, Salim S. MD; Ho, Vivian PhD

doi: 10.1097/MLR.0b013e318245a64d
Original Articles

Background: Although Medicare eligibility has been shown to generally increase health care access and utilization, few studies have investigated the association between Medicare eligibility and health care utilization among the chronically ill.

Objective: This study examines changes in health care access and utilization associated with Medicare eligibility among adults with coronary heart disease and stroke (CHDS).

Methods: Descriptive statistics and regression discontinuity analysis were used to examine health care access and utilization at age 65 when Medicare eligibility begins for 176,611 National Health Interview Survey respondents aged 55–74 surveyed between 1997 and 2010.

Results: We found that adults with CHDS reported a higher propensity to make 1+ office-based physician visits at age 65 (1.7%, P=0.03) than adults with no major chronic disease (0.5%, P=0.07). Adults with CHDS also reported greater reductions in cost as a barrier to care at age 65 (−3.6%, P < 0.01) than adults with no major chronic disease (−2.0%, P=0.01). The subgroup analysis revealed that Hispanics and highly educated adults with CHDS reported the highest propensity to make 2+ office visits at age 65 (9.5%, P=0.04 and 2.4%, P < 0.01). However, blacks with CHDS reported a decline in their propensity to make 2+ office visits at age 65 (−2.1%, P=0.05).

Conclusions: Medicare eligibility improves health care access and utilization for many adults with CHDS, but it may not promote appropriate levels of physician use among some groups.

Supplemental Digital Content is available in the text.

*Department of Economics MS-22, Rice University

Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center

James A. Baker III Institute for Public Policy, Rice University, Houston, TX

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

The authors acknowledge the Karen Davis Endowment at Rice University.

The authors declare no conflict of interest.

Reprints: Jerome Dugan, MA, Department of Economics MS-22, Rice University, Houston, TX 77251-1892. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.