Improvements in Cancer Detection and Mortality under Nearly-Universal Medicare Coverage

What is it about?

Medicare, one of the largest public insurance program in the U.S., provides nearly universal health insurance coverage to Americans over age 65. Yet, its impact on health outcomes and mortality are debated in the academic literature. This paper examines whether enrolling in Medicare has an impact on cancer detection and outcomes. The analysis focuses on breast, colorectal, and lung cancer— diseases with recommended screening both before and after age 65— and assesses changes in detection and mortality or older adults just above vs. below age 65 between the years 2001 and 2015 using a regression discontinuity design. The researchers found cancer detection increased by 50 per 100,000 at age 65, a 10 percent increase compared to people 63 and 64 years old. Cancer mortality decreased by 9 per 100,000 population for women, a 4.5% decrease compared to women 63 to 64 years old, but did not significantly change for men. There were also differences by race; for example, Black women experienced a particularly large decrease in mortality at age 65. Multiple checks, including comparison with data from Canada as a placebo check, suggested the robustness of findings. These estimates provide new evidence of Medicare’s impact on health outcomes for people in need of medical care.

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Why is it important?

Given that older adults served by Medicare will account for 70 percent of cancer patients by 2030, understanding the influence of Medicare coverage is vital for public policy. This paper is the first to provide evidence that nearly universal Medicare coverage leads to reductions in cancer mortality, with particularly large improvements for under-served populations such as Black women. Thus, in addition to improvements in health, the results highlight an improvement in health equity among women with cancer.

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