Cooperative Public Health Insurance System: Effects of Medicare Buy-In Programs on Health Care Utilization

Abstract

The paper examines the effect of the U.S. Medicare Buy-In program, a cooperative public health insurance system, on the health care use among Medicare beneficiaries. Zero-inflated negative binomial (ZINB) regression analysis is performed over the sample of 8,262 Medicare beneficiaries extracted from the U.S. Medical Expenditure Panel Survey 1996-2000. Dual eligibles are correlated with more utilization of agency-sponsored home healthcare services. The high utilization of home healthcare services among dual eligibles is the result of delayed realization of unmet need under the conventional Medicare program, but not the result of possible over-utilization triggered by the Medicare-Medicaid dual coverage. The Buy-In program is found to be a supportive hand over the Medicare low-income group with unmet medical care needs. The program is particularly beneficial to racial minority duals (rather than white duals) in receiving home health care or dental services.