Surge in hospital use is unlikely to result from a US ‘Medicare for All’ scheme
Analysis based on trends observed following the implementation of the Affordable Care Act predicts no net increase in hospitalizations following the potential implementation of Medicare for All.
As the benefits of a US Medicare for All program are debated, some predict that the implementation of such national health coverage could overwhelm the health system with increased hospitalizations and costs. However, a new study conducted by researchers at Harvard Medical School (MA, USA) and City University of New York’s Hunter College (NY, USA) has instead predicted a redistribution of care that will not result in a net hospitalization increase.
In the study, researchers analyzed national surveys and assessed hospital use records concerning newly covered individuals and of individuals whose health cover did not change prior to, and following, the implementation of Medicare and Medicaid in 1966, as well as the 2014 Affordable Care Act.
Both the Affordable Care Act, Medicare and Medicaid programs increased health coverage for the US population by approximately 10%; this is a similar coverage increase as is expected to result from a Medicare for All policy.
In 1963 – 3 years prior to Medicare implementation – hospital admissions were found to average to 12.8 per 100 individuals. 4 years following Medicaid introduction – in 1970 – hospital admissions averaged 12.7 per 100 persons.
Likewise, in 2008, 6 years prior to the Affordable Care Act, hospital admissions averaged 9.4 per 100 persons; this figure was not statistically altered by 2016 – 2 years after the Act.
These statistically unchanged hospital admissions averages reflected a redistribution of hospital care from the healthy and wealthy to the elderly and poorer that gained health coverage under these programs.
For example, following Medicaid introduction, hospitals admissions of elderly persons rose by 3.7 per 100 individuals. Admissions of individuals within the poorest one-third of the US population also rose by 0.7 per 100 persons. Concurrently, however, hospitalizations of healthier (younger) and wealthier persons fell by 0.6 per 100.
Steffie Woolhandler, study contributing author and Professor of Urban Public Health at Hunter College, stated: “The good news is that even big coverage expansions didn't increase hospitalizations overall, indicating that universal coverage won't cause a surge in care, and that Medicare for All is affordable.”
The researchers predict that other studies that forecasted health system overwhelming following Medicare for All may have failed evaluate the effects of the program on individuals for whom cover is to be unchanged.
David Himmelstein, also Professor of Urban Public Health at Hunter College, and lecturer at Harvard Medical School, commented: “We've long known that when people get new or better coverage, they use more health care…What we didn't know is what happens to those who were already well-insured, and how this plays out society-wide given the limited number of hospital beds, doctors and nurses…Our data shows that if you sensibly control hospital growth, you can cover everybody without breaking the bank.”
Adam Gaffney, lead study author and Instructor in medicine at Harvard Medical School, did not express concern over the reduced hospital admissions observed for those whose care coverage did not change.
Gaffney commented: “We know that the well-insured often receive unnecessary hospitalizations…The fact that coverage expansions shift hospital care to those who need it, and reduce care for groups currently getting excessive and possibly harmful interventions, means that universal coverage could help everyone.”
Gaffney A, McCormick D, Bor DH. The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States. Ann. Intern. Med. Doi: 10.7326/M18-2806 (Epub ahead of print)(2019);