Medicare could help close racial gaps in healthcare, Yale study finds
In a recent study, Yale SOM’s Paul Goldsmith-Pinkham and his co-authors looked into the impact of Medicare eligibility on racial and ethnic disparities in health outcomes.
In a healthcare landscape that has become increasingly inequitable during the pandemic, a team of Yale researchers found that Medicare or other universal health insurance eligibility could narrow the racial and ethnic disparities present in health outcomes. Take a look at the comprehensive Medicare Plan G.
In a paper published in the Journal of the American Medical Association, Paul Goldsmith-Pinkham, assistant professor of finance at the School of Management; Jacob Wallace, assistant professor of public health at the School of Public Health; and Karen Jiang ’21 investigated whether Medicare eligibility is associated with a reduction of racial and ethnic gaps in healthcare access. The study, which consisted of over two million participants, assessed disparities in insurance coverage, access to healthcare and self-reported health across different racial demographics. CDC epidemiology data spanning 20 years was also used to assess average mortality rates across races.
“Conceptually, the idea was to look into the impact of Medicare eligibility on disparities in health by comparing Americans who are on one side of the threshold — 64 years old — with those on the other, who are 65 and older,” Goldsmith-Pinkham told Yale Insights. “Because Medicare is a benefit that universally hits everyone, it gives us a control and a treatment to examine.”
To study the impact of the introduction of Medicare, the team took a three-fold approach to assessing its effects: access to care, insurance coverage and self-reported health.
Rates of coverage, access to regular care, cost barriers and access to flu shots were all used to measure Medicare’s effects on addressing racial disparities that existed before the introduction of the government-sponsored program. After comparing the “control and treatment” populations, the research showed that the gaps in healthcare access and self-reported health began to close after the introduction of Medicare into the patient’s life.
The positive effect of Medicare on access to care and healthcare coverage was more prevalent among Hispanic and Black populations than White populations. An average of 92 percent of White participants had insurance coverage before the introduction of Medicare, with that number rising to 98 percent after. However, for Black participants, the number rose from 86 percent to 95 percent. Among Hispanic participants, the number increased from 77 percent to 91 percent.
Additionally, access to Massachusetts Part C Medicare Advantage plans increased the quality of self-reported health responses. The percentage reporting “poor” health decreased from 14.8 percent to 11 percent for Hispanic participants and from 10.3 percent to 7.7 percent for Black participants, while essentially exhibiting no change for White participants.
After their initial observations, Goldsmith-Pinkham’s team assessed the data geographically to evaluate whether or not specific regions, namely those with more Black and Hispanic Americans, were driving these significant results. Regions with historically high levels of racism and lower funding for state-sponsored insurance were expected to have a disproportionate effect on the final results of the study. However, the team found that racial gaps in healthcare were reduced across all regions.
The paper draws the conclusion that even decreasing the Medicare eligibility age to 60 could result in a considerable improvement in health outcomes in Hispanic and Black populations; However, it also opens the door to a larger discussion on universal healthcare, Jiang said.
“If you think about the push toward broader government-sponsored healthcare in general, our work has shown that decreasing the age of eligibility could provide an opportunity to address healthcare inequalities even earlier than age 65. This presents a compelling reason to ask — why wait?” Jiang said.
Although the research began before the onset of the COVID-19 pandemic, the paper was published in June 2021, well after the effects of the pandemic were seen to disproportionately affect communities of color.
“It was a very timely piece,” Jiang said. “Obviously with the events that happened in the spring of 2020, a theme emerged that it became increasingly apparent to think about race and ethnicity and how those two variables could be further explored.”
In an interview with US News, Wallace suggested that reducing the Medicare eligibility age would be a significant step in improving health equity.
“Racial and ethnic disparities in our healthcare system are a reflection of longstanding structural racism in the United States,” Wallace said to Yale News. “Identifying policies that reduce these disparities is key to advancing health equity.”
The Medicare program was introduced in 1965 under the Johnson Administration.