Insurance coverage has been shown to increase the likelihood of a patient visiting his or her physician, especially in an outpatient, primary care setting.1 Since 2010, the Affordable Care Act has required health insurance companies to cover preventative care, such as cancer and chronic disease screenings. Despite these changes, improvements in screening rates for patients on private insurance have been modest.1 Most Americans become eligible for government-subsidized Medicare insurance at age 65 but may not join Medicare right at age 65 if they have private insurance or can qualify for coverage earlier due to a disability or other factor. Some previous studies have suggested that cancer screening and subsequent care is more likely at age 65, which researchers posit is due to increased insurance coverage with Medicare eligibility.2,3 To further investigate whether these increases are correlated more closely with when a patient starts their initial Medicare coverage than with the patient’s age, we investigated the effect of having Medicare insurance coverage on cancer screening and diagnosis rates and chronic disease diagnosis rates.
First, we looked at cancer screening rates during the year of a patient’s first Medicare encounter. We found that colorectal cancer screenings nearly doubled when the patient started Medicare coverage, while breast cancer screenings increased by about 50%, as shown in Figure 1. These elevated screening rates continued beyond the first year of coverage.
To investigate whether an increase in access to healthcare and screenings resulted in new diagnoses, we evaluated 20,271,595 patients between the ages of 60 and 70 years old to see whether diagnoses for 14 common conditions occurred with greater frequency when patients had their first Medicare-covered encounter compared to when they were previously uninsured or covered by another insurer. We found that initial diagnosis of 10 of the 14 conditions—breast cancer, colorectal cancer, prostate cancer, lung cancer, hypertension, hyperlipidemia, coronary heart disease, type 2 diabetes, depression, and COPD—were more commonly diagnosed in the year the patient had their first Medicare encounter than in any of the five years before or after, as shown in Figure 2.
A main goal of the Medicare program is to help eligible patients receive appropriate management for chronic conditions, which starts with diagnosing the condition.4 As shown in Figure 2, hyperlipidemia, hypertension, depression, type 2 diabetes, and coronary heart disease are commonly discovered and documented during the first year of Medicare eligibility. The same is true for lung, breast, prostate, and colorectal cancer. This aligns with previous studies showing a “Medicare effect” on the timing of cancer diagnoses.2,3
Some conditions, like dementia, chronic kidney disease, heart failure, and arthritis are more likely to be diagnosed before Medicare coverage takes effect. This might be because these diseases are more likely to have noticeable symptoms that might prompt a patient to seek medical care.
Original Publication Date: July 26, 2023
Last Updated: August 4, 2023
